Systematic Review: Newer Perspective in the Medical Management of Acute Ischaemic Stroke
Keywords:
Acute ischaemic stroke, Medical management, Alteplase, Antithrombotic agents, NeuroprotectantsAbstract
Introduction: Acute ischaemic stroke (AIS) remains a leading cause of mortality worldwide, where timely management is crucial in minimising neurological damage. This study reviews the latest evidence concerning the medical management AIS.
Methods: A systematic literature review was conducted using the EMBASE database to explore medical management strategies for AIS. Systematic reviews and meta-analyses from the past five years underwent abstract screening by two reviewers. Eligible abstracts were then evaluated through full-text reading based on the eligibility criteria. Out of 174 identified citations, 21 studies were included in the narrative analysis.
Results: Current evidence supports alteplase as the first-line treatment for AIS. However, tenecteplase is emerging as a promising alternative with similar efficacy and lower risks. Recent clinical trials suggested the use of aspirin within 24 hours of onset, and the consideration of dual antiplatelet therapy for prevention. Routine use of anticoagulants is discouraged, but low molecular weight heparin may have a role in certain stroke types. Emerging neuroprotective agents like edaravone, minocycline, vinpocetine, and salvianolic acids show promise but require more research for inclusion in treatment guidelines.
Conclusion: Medical management of AIS primarily relies on alteplase as the gold-standard treatment. Our analysis highlights tenectaplase as a possible alternative as well as the potential benefits of antithrombotic agents and neuroprotectants for post-stroke recovery and prevention. With variations in clinical efficacy outcomes due to limited subgroup analyses, it is important to conduct large multicentre trials to further evaluate the various management strategies in order to establish optimal care which is personalised.
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Copyright (c) 2025 Ananya Sanagavaram, Kenji Miyauchi, Mara Optasanu, Sara Betzhold, Christopher Murray, Frank Corssen
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