Nadezhda Vasilyeva: Shifting the Boundaries of Acute Ischemic Stroke Management
Nadezhda Vasilyeva, Neurologist, shared a post on LinkedIn:
“The boundaries of acute ischemic stroke management are shifting: the 2026 AHA/ASA guidance allows tenecteplase 0.25 mg/kg as an alternative to alteplase within 4.5 hours or less; concurrently, trials (e.g. HOPE) are investigating selective thrombolysis expansion to 4.5-24 hours using perfusion-based selection.
Antithrombotic management after reperfusion remains a trade-off: ATIS‑NVAF data showed increased bleeding without clear clinical benefit when combining anticoagulants and antiplatelets.
The emergence of Factor XIa inhibitors (e.g. asundexian; Phase III OCEANIC‑STROKE) shows reduced recurrence with an acceptable bleeding profile – potentially addressing a key neuro-safety dilemma.
As a clinician with 5+ years in neurology, I translate this bedside experience into rigorous ICH‑GCP safety monitoring.
Colleagues in research teams – how are you adapting monitoring systems for extended thrombolysis windows and new antithrombotic combinations?”
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