Early Antithrombotic Strategies in Acute Stroke: From Immediate Intervention to Early Prevention of Secondary Stroke

This Research Topic will comprehensively explore the evolving landscape of antiplatelet and anticoagulation therapies for acute ischemic stroke, with a particular emphasis on the use of these agents for early intervention and secondary prevention during the first hours following stroke onset. Antithrombotic management has transitioned from agents such as warfarin and heparin to the widespread use of antiplatelet drugs—including aspirin, clopidogrel, and the implementation of dual antiplatelet therapy (DAPT)—as well as the introduction of direct oral anticoagulants (DOACs) for selected patients. Contributions are encouraged to address evidence from pivotal trials evaluating agents like aspirin and clopidogrel for ultra-early administration, as well as trials supporting DAPT in minor stroke or high-risk transient ischemic attack. The role of ticagrelor and other novel oral antiplatelets in acute management, and the use of advanced anticoagulants such as factor XIa inhibitors for patients with atrial fibrillation, will be explored in the context of the earliest phases of stroke care. Special attention will be given to practical questions regarding patient selection (including the use of thromboelastography, genetic and biomarker profiling), optimal timing and combination of therapies. The collection will synthesize lessons from historical practice and recent innovation—highlighting both real-world and trial-based evidence—to define best practices and identify gaps for future research. Ultimately, this Topic aims to inform rapid, individualized antithrombotic strategies that maximize benefit and safety in the early care of acute ischemic stroke. Topic editors: David S Liebeskind, Nijasri C. Suwanwela, Jorge G Ortiz Source: https://www.frontiersin.org/research-topics/77323/early-antithrombotic-strategies-in-acute-stroke-from-immediate-intervention-to-early-prevention-of-secondary-stroke