GLP-1 Receptor Agonists in Acute Ischemic Stroke and Secondary Stroke Prevention: A Narrative Review of Preclinical and Clinical Evidence.

In a small retrospective cohort of 123 patients with diabetes hospitalized for AIS, GLP-1RA use documented at admission and/or prescribed at discharge, therefore partially reflecting prior exposure, was associated with numerically lower 1-year stroke recurrence (Log Odds Ratio [LOR] 1.13, 95% CI 3.21–0.95, P=0.28) and higher odds of functional independence at 90 days (LOR 2.38, 95% CI 0.12–4.87, P=0.06), but these associations did not reach statistical significance. 66 In a larger retrospective study of 69,005 patients with ischemic stroke treated with intravenous thrombolysis, GLP-1RA initiation within 6 months after the index event was associated with lower all-cause mortality (HR 0.61, 95% CI 0.39–0.93), fewer emergency department visits (HR 0.78, 95% CI 0.63–0.95), and fewer inpatient hospitalizations during follow-up (HR 0.69, 95% CI 0.55–0.85). 67 Notably, this analysis evaluated early post-stroke initiation rather than pre-event exposure and cannot establish neuroprotection in the acute phase.

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