Antithrombotic therapy for stroke in the near future

Abstract

Recent Advance in Antiplatelet Therapy : The problem of clopidogrel–refractory cases derived from CYP2C19 gene polymorphisms has been highlighted. The frequency is particularly high in high–risk cases on Fukuoka Stroke Risk score for Japanese. Prasugrel was developed in Japan to address this problem, and the PRASTRO trial added it to the treatment options for atherothrombotic and lacunar infarctions. Dual Pathway Inhibition utilizing Factor XIa inhibitors : Factor XI is in the spotlight as a target that can inhibit thrombosis while preserving the hemostatic mechanism. The application of dual pathway inhibition, i.e. antiplatelet plus anticoagulation, in the treatment of non–cardiogenic stroke is being investigated, and phase III trials with milvexian and asundexian are underway. New Generation Thrombolytic Drug : Currently, a series of investigator–initiated clinical trials are being conducted to apply tenecteplase, which is used overseas as a treatment for myocardial infarction, to the treatment of cerebral infarction. In many countries, clinical application has begun with off–label use, and tenecteplase is gaining recommendations as a treatment for cerebral infarction in foreign guidelines. In Japan, T–FLAVOR trial is underway to prove efficacy and safety of tenecteplase in Japanese population.