Abstract: Acute ischemic stroke (AIS) is associated with high mortality and disability rates, presenting a substantial challenge to global public health challenge. Intravenous thrombolysis (IVT) is recognized as a cornerstone of early AIS treatment and is recommended as the standard therapeutic approach by both national and international guidelines. However, the clinical efficacy of IVT remains suboptimal due to several limitations, including a narrow therapeutic time window and the inevitable activation of the coagulation system and platelet aggregagation during thrombolysis. These factors may contribute to adverse outcomes such as early neurological deterioration (END) and vascular re-occlusion. Antiplatelet therapy (APT), which inhibits platelet aggregations, reduces microthrombus formation, and stabilizes the vascular endothelium with multifaceted mechanisms, has emerged as a promising adjunctive strategy to IVT, offering potential synergistic effects. This review summarized the latest evidence from both domestic and international studies, focusing on the mechanisms of APT, recent clinical advancements in IVT combined with APT, and the safety and efficacy of APT administration at different time windows relative to IVT. Emphasis is placed on the influence of various antiplatelet agents, dosing regimens, and initiation timing on therapeutic outcomes, alongside a comprehensive evaluation in the context of current guideline recommendations and clinical practice. Current guidelines recommend initiating APT 24 h after IVT, following imaging confirmation to exclude the risk of intracranial hemorrhage. However, the efficacy and safety of earlier APT initiation remain inconclusive. Individualized treatment strategies, such as early administration of low-dose, short-acting APT or combination therapy in specific patient subgroups, may effectively balance therapeutic benefits and risks. The adjunctive use of APT in IVT holds promise for enhancing efficacy and improving clinical outcomes, but precise stratification of safety and efficacy is essential. Future research should focus on optimizing combination IVT and APT strategies through individualized patient profiling, appropriate drug selection, and dynamic imaging monitoring to achieve precision management in AIS treatment.

Key words: antiplatelet therapy,  , ischemic stroke, acute phase, intravenous thrombolysis, early combined treatment