Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Aug;56(8):2369-2374.
doi: 10.1161/STROKEAHA.125.051818. Epub 2025 Jul 28.

Adjunctive Antithrombotic Medications to Acute Reperfusion Therapy: Current Evidence and Future Directions

Lauren E Menzies #  1 , Yasmin N Aziz #  1 , Opeolu Adeoye  2 , Joseph P Broderick  1
Affiliations
Review

Adjunctive Antithrombotic Medications to Acute Reperfusion Therapy: Current Evidence and Future Directions

Lauren E Menzies et al. Stroke. 2025 Aug.

Abstract

Thrombolytics and mechanical thrombectomy are standard of care therapies for the treatment of acute ischemic stroke. Optimizing reperfusion beyond these 2 interventions is a critical next step to improving patient outcomes. The utility of antithrombotic medications is well-established for secondary stroke prevention, but their role as adjunctive therapies to achieve or optimize reperfusion in the acute setting remains investigational. This article discusses the rationale for the use of adjunctive antithrombotic medications in combination with reperfusion therapies and reviews key trials exploring their use. We will use the term adjunctive to refer to any antithrombotic intervention that is added acutely to the standard of care of thrombolysis or thrombectomy to improve patient outcomes. A brief discussion on the future of adjunctive therapies for current reperfusion strategies and the best use of antithrombotic medications in the hospital setting are additionally presented.

Keywords: ischemic stroke; reperfusion; standard of care; stroke; thrombectomy.

PubMed Disclaimer

Conflict of interest statement

Dr Adeoye is the founder, equity holder, and CMO for Sense Diagnostics, Inc, received salary and grant support from the National Institutes of Health/National Institute of Neurological Disorders and Stroke, and received compensation from NICO Corporation for data and safety monitoring services. Dr Broderick is the Clinical Advisory Board member for Basking Biosciences; received consulting fees from Roche Pharmaceuticals/Genentech, Kroger Prescription Plans, Inc, Pharmacy & Therapeutics Committee (ended January 2025); study medication and financial support (not salary) from Novo Nordisk for National Institute of Neurological Disorders and Stroke-funded FASTEST trial (rFVIIa for Acute Hemorrhagic Stroke Administered at Earliest Time); and compensation from BrainsGate for consultant services. Dr Aziz receives funding from the American Heart Association. The other authors report no conflicts.

Similar articles

See all similar articles

References

    1. Angiolillo DJ, Galli M, Collet JP, Kastrati A, O'Donoghue ML. Antiplatelet therapy after percutaneous coronary intervention. EuroIntervention. 2022;17:e1371–e1396. doi: 10.4244/EIJ-D-21-00904 - DOI - PMC - PubMed
    1. Kandan SR, Johnson TW. Contemporary Antiplatelet Strategies in the Treatment of STEMI using Primary Percutaneous Coronary Intervention. Interv Cardiol. 2015;10:26–31. doi: 10.15420/icr.2015.10.1.26 - DOI - PMC - PubMed
    1. Gale AJ. Continuing education course #2: current understanding of hemostasis. Toxicol Pathol. 2011;39:273–280. doi: 10.1177/0192623310389474 - DOI - PMC - PubMed
    1. Heestermans M, Poenou G, Hamzeh-Cognasse H, Cognasse F, Bertoletti L. Anticoagulants: A Short History, Their Mechanism of Action, Pharmacology, and Indications. Cells. 2022;11. doi: 10.3390/cells11203214 - DOI - PMC - PubMed
    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50:e344–e418. doi: 10.1161/STR.0000000000000211 - DOI - PubMed

Substances