<p>This article addresses current aspects of the management of patients with ischemic and hemorrhagic stroke (IS and HS). The roles of genetic predisposition and lifestyle, air pollution with fine particles, temperature factors, anatomical features of cerebral vessel structure, stress, depression, and sleep disorders in the development of IS and HS are discussed. The role of anticoagulant drugs (AC) as a new risk factor for HS is discussed. The pathophysiology of IS and HS is considered, in particular, the mismatch of blood flow and metabolism and the stability of the penumbra in IS, as well as changes in perfusion and cerebral blood flow in HS and autoimmune mechanisms of brain damage. The issues of expanding the therapeutic window, using new-generation thrombolytic drugs, and telethrombolysis and thrombolysis (TLT) in mobile stroke units are discussed. The tactics of prescribing factor IIa and Xa blockers to patients taking AC during TLT are discussed. We address the emergency correction of hemostasis in the development of HS while taking AC, as well as subsequent resumption of AC. Neuroprotection, including the combination of neuroprotection and thrombolytic therapy, and the translation of experimental studies into clinical practice are discussed, as is immunomodulatory therapy.</p>