In the case of a patient presenting with ischemic stroke after a prolonged delay, what is the best pharmacotherapy option?

In situations where a patient presents with an ischemic stroke after a prolonged delay, the best pharmacotherapy option is to initiate aspirin therapy. Aspirin plays a critical role in secondary prevention of stroke, particularly for patients who have already experienced an ischemic event. It works by inhibiting platelet aggregation, thereby reducing the risk of further clot formation.

The use of alteplase (a thrombolytic agent) is typically restricted to patients presenting within a specific time window, usually within three to four and a half hours of symptom onset. After a prolonged delay, the risks associated with thrombolysis outweigh the potential benefits, making alteplase unsuitable.

Adjusting or increasing doses of antihypertensives like lisinopril and amlodipine is not the immediate goal in acute stroke management. While blood pressure control is important overall in managing stroke risk, it does not address the acute ischemic event effectively at this moment.

Starting intravenous fluids can be part of general supportive care for a patient but is not an effective treatment for acute ischemic stroke. Aspirin, on the other hand, directly targets the thrombotic component of the ischemic stroke process and is a well-established treatment for this scenario, thus making it the most appropriate choice