[Acute-Phase Medical Treatment:Treatment to "Reduce" the Risk of Symptom Worsening].

Abstract

Acute medical management after acute ischemic stroke (AIS) is often perceived as a supportive or conservative treatment, following decisions regarding intravenous thrombolysis and mechanical thrombectomy. However, it should be regarded as an active strategy to reduce the risk of neurological deterioration and support subsequent recovery. Acute medical treatment can be divided into two components: prevention of recurrent stroke or infarct expansion, and prevention of systemic complications that may delay recovery. This approach mainly aims at preventing early neurological deterioration (END), a clinically important but variably defined phenomenon associated with poor functional outcomes. Estimating the risk of END at admission using the clinical background, comorbidities, frailty, stroke mechanism, vascular imaging, and infarct distribution guides treatment intensity and monitoring. In patients with non-cardioembolic AIS with a high risk of END, antithrombotic strategies, including prasugrel and argatroban, may be considered while balancing the risk of bleeding. Recent randomized trials support earlier initiation of direct oral anticoagulants in selected patients with cardioembolic stroke. General medical care, including hemodynamic management, mobilization, swallowing assessment, and nutrition, is essential to prevent deterioration and promote recovery.