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54 - Antithrombotic Therapy for Treatment of Acute Ischemic Stroke
Book chapter

54 - Antithrombotic Therapy for Treatment of Acute Ischemic Stroke

Harold P Adams and Patricia H Davis
Stroke, pp.773-785.e4
Elsevier Inc, Seventh Edition
2022
DOI: 10.1016/B978-0-323-69424-7.00054-5

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Abstract

Aspirin therapy (initial dose of 325 mg and subsequently 81 mg a day) should be initiated in acute stroke patients within 24 to 48 hours. Patients receiving thrombolytic therapy should delay treatment until after 24 hours. Antiplatelet agents are preferred therapy for most patients with stroke not secondary to cardioembolism and should be initiated prior to hospital discharge. Following transient ischemic attack or minor stroke, a 21-day course of dual antiplatelet therapy with aspirin and clopidogrel, following clopidogrel loading, is safe and effective and should be initiated within 24 hours. Dual antiplatelet therapy is safe for up to three months in patients with a low risk of bleeding. Parenteral administration of anticoagulants or antiplatelet agents as a primary therapy to improve outcomes after acute ischemic stroke is not effective. These agents are associated with an increased risk of intracerebral hemorrhage. They should not be considered as an alternative to treatment of acute ischemic stroke with intravenous thrombolysis and/or endovascular interventions. In immobilized patients following stroke, deep vein thrombosis prophylaxis should be started early using low-molecular-weight heparin, heparin, and/or intermittent compression stockings. The timing of starting treatment with oral anticoagulants for long-term prevention of recurrent stroke in patients with cardioembolism is unclear, and the size of the ischemic stroke should be considered. The new oral anticoagulants are associated with a lower risk of intracerebral hemorrhage than warfarin but have not been tested in patients with acute stroke. The plan for treatment with oral anticoagulants should be finalized before hospital discharge.
 intracerebral hemorrhage deep vein thrombosis aspirin Anticoagulation cardioembolism dual antiplatelet

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