Volume : 13, Issue : 06, June – 2026
Title:
EVOLVING PARADIGMS IN SECONDARY STROKE PREVENTION: A COMPREHENSIVE REVIEW OF DUAL ANTIPLATELET THERAPY, INTENSIVE LIPID-LOWERING, AND BIOMARKER-DRIVEN STRATIFICATION
Authors :
Jasna Mariyam T.N, Aleena Anson, Anjana.A, Shifana K.S, Mrs. Rajasree S, Dr. T. Tamilselvan
Abstract :
In order to develop optimal, customized procedures for secondary stroke prevention, this study aims to critically assess and synthesize recent developments in clinical trials, mechanistic evidence, and subgroup studies in acute-phase pharmacology. In order to accomplish this, the review systematically examines the safety thresholds, optimal therapeutic windows, and clinical efficacy of combination antithrombotic and high-intensity lipid-lowering regimens. It also discusses how these treatments interact with various patient comorbidities and newly discovered pathophysiological biomarkers to improve risk stratification. By combining data from multicentred registries, secondary subgroup studies, and recent clinical trials published between 2005 and 2026, a thorough literature synthesis was carried out. The Intensive Statin and Antiplatelet Therapy for High-Risk Intracranial or Extracranial Atherosclerosis (INSPIRES) study and short-term intensive statin and dual antiplatelet therapy (DAPT) protocols were the main focus of the systematic evaluation of data from thirty significant studies. Therapeutic initiation latency, recurrent ischemic stroke occurrences, bleeding events, non-traditional metabolic indices, particularly oxidized low-density lipoprotein (ox-LDL) and the stress hyperglycaemia ratio (SHR), and structural healthcare inequities were among the variables that were retrieved. The obtained data shows that extending the treatment window for DAPT initiation to 72 hours after the ictus considerably reduces the probability of a 90-day ischemia recurrence without increasing the risk of serious haemorrhagic consequences. Early micro emboli suppression and endothelial stabilization are provided concurrently by hyper-acute intensive statin regimens, especially in branch atheromatous disease and carotid stenosis. In the end, the successful mitigation of residual ischemic risk is made possible by incorporating patient-specific metabolic profiles and physiological biomarkers like SHR, ox-LDL, and the BUN/Cr ratio. This demonstrates that tailored secondary prevention that strikes a balance between aggressive pharmacology and individual comorbidity profiles is crucial to optimizing stroke care worldwide.
Keywords: Acute Ischemic Stroke; Transient Ischemic Attack; Dual Antiplatelet Therapy; HMG-CoA Reductase Inhibitors; INSPIRES Trial; Biomarkers; Secondary Prevention.
Cite This Article:
Please cite this article in press Jasna Mariyam T.N et al., Evolving Paradigms In Secondary Stroke Prevention: A Comprehensive Review Of Dual Antiplatelet Therapy, Intensive Lipid-Lowering, And Biomarker-Driven Stratification, Indo Am. J. P. Sci, 2026; 13(06).
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