Acute ischemic stroke (AIS) is the most common type of stroke and requires immediate reperfusion. Current acute reperfusion therapies comprise the administration of intravenous thrombolysis and/or endovascular thrombectomy. Although these acute reperfusion therapies are increasingly successful, optimized secondary antithrombotic treatment remains warranted, specifically to reduce the risk of major bleeding complications. In the development of AIS, coagulation and platelet activation play crucial roles by driving occlusive clot formation. Recent studies implicated that the intrinsic route of coagulation plays a more prominent role in this development, however, this is not fully understood yet. Next to the acute treatments, antithrombotic therapy, consisting of anticoagulants and/or antiplatelet therapy, is successfully used for primary and secondary prevention of AIS but at the cost of increased bleeding complications. Therefore, better understanding the interplay between the different pathways involved in the pathophysiology of AIS might provide new insights that could lead to novel treatment strategies. This narrative review focuses on the processes of platelet activation and coagulation in AIS, and the most common antithrombotic agents in primary and secondary prevention of AIS. Furthermore, we provide an overview of promising novel antithrombotic agents that could be used to improve in both acute treatment and stroke prevention.

中文翻译：

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急性缺血性卒中当前和潜在的新型抗血栓治疗

急性缺血性中风（AIS）是最常见的中风类型，需要立即再灌注。目前的急性再灌注疗法包括施用静脉溶栓和/或血管内血栓切除术。尽管这些急性再灌注疗法越来越成功，但优化的二级抗血栓治疗仍然是必要的，特别是为了降低大出血并发症的风险。在 AIS 的发展过程中，凝血和血小板活化通过驱动闭塞性凝块形成发挥着至关重要的作用。最近的研究表明，凝血的内在途径在这一发展中发挥着更重要的作用，然而，这一点尚未完全了解。除了急性治疗之外，由抗凝剂和/或抗血小板治疗组成的抗血栓治疗已成功用于 AIS 的一级和二级预防，但代价是增加出血并发症。因此，更好地了解 AIS 病理生理学不同途径之间的相互作用可能会提供新的见解，从而产生新的治疗策略。本综述重点介绍 AIS 中血小板活化和凝血的过程，以及 AIS 一级和二级预防中最常见的抗血栓药物。此外，我们还概述了有前景的新型抗血栓药物，这些药物可用于改善急性治疗和中风预防。