{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T04:32:27Z","timestamp":1769747547911,"version":"3.49.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,10]],"date-time":"2021-09-10T00:00:00Z","timestamp":1631232000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Recent studies of interventions initiated acutely following onset of minor ischemic stroke or transient ischemic attack (TIA) have disclosed early stroke recurrence rates that are substantially higher than long-term recurrence rates and that can be reduced by acute antiplatelet treatment interventions. These observations, bolstered by analysis based on kinetic modeling of the time course of recurrence following initial events, suggest that acute stroke patients experience an underlying vulnerable state that quickly transitions to a more stable state. Some evidence also supports the benefits of early treatment with direct-acting oral anticoagulants in cardioembolic stroke and of continuation or early initiation of statin therapy in atherosclerotic stroke. Treatment of ischemic stroke should address the transient vulnerable state that follows the initial event, employing measures aiming to avert early recurrence of thromboembolism and to promote stabilization of vulnerable arterial plaque. These measures constitute <jats:italic>acute secondary prevention<\/jats:italic> following ischemic stroke.<\/jats:p>","DOI":"10.3389\/fneur.2021.701168","type":"journal-article","created":{"date-parts":[[2021,9,10]],"date-time":"2021-09-10T04:34:08Z","timestamp":1631248448000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Acute Secondary Prevention of Ischemic Stroke: Overlooked No Longer"],"prefix":"10.3389","volume":"12","author":[{"given":"Zachary B.","family":"Bulwa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott J.","family":"Mendelson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James R.","family":"Brorson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2901","DOI":"10.1001\/jama.284.22.2901","article-title":"Short-term prognosis after emergency department diagnosis of TIA","volume":"284","author":"Johnston","year":"2000","journal-title":"JAMA."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1533","DOI":"10.1056\/NEJMoa1412981","article-title":"One-year risk of stroke after transient ischemic attack or minor stroke","volume":"374","author":"Amarenco","year":"2016","journal-title":"N Engl J Med."},{"key":"B3","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1016\/S0140-6736(97)04010-5","article-title":"CAST: randomized placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke","volume":"349","author":"CAST","year":"1997","journal-title":"Lancet."},{"key":"B4","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1016\/S0140-6736(97)04011-7","article-title":"The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. 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