Stroke. Conclusion

Despite the large number of clinical studies, there are important unanswered issues concerning the management of patients with ischemic cerebrovascular events. In the acute management of stroke, there are many ongoing clinical trials with antithrombotic drugs, as well as neuroprotective agents, which are being tested with time windows of 90 minutes to 48 hours. For the long-term protection from stroke, clinical trials have yielded alternatives: antiplatelet agents and warfarin. The choice of the best therapy depends upon recognizing the clinical syndrome, determining the infarct subtype, and evaluating risk factors.

For certain high-risk conditions such as nonvalvular atrial fibrillation, prosthetic valves, acute myocardial infarction, and cardioembolic stroke, warfarin is probably indicated. The dose, duration, need for combination therapies, and role of warfarin in non-cardioembolic stroke are remaining questions. Clearly, more work needs to be done in the prevention and treatment of ischemic stroke to achieve our goals of reducing the public health burden of stroke.

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