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Uptodate Reference Title
Antithrombotic therapy according to cause of acute ischemic stroke
Antithrombotic therapy according to cause of acute ischemic stroke
This algorithm is intended to provide basic guidance regarding the immediate use of antithrombotic therapy for patients with an acute ischemic stroke. For further details, including scoring of the NIHSS and suggested dosing regimens of antithrombotic agents, refer to the relevant UpToDate topic reviews.
HTN: hypertension; SBP: systolic blood pressure; DBP: diastolic blood pressure; ICA: internal carotid artery; CEA: carotid endarterectomy; OA: oral anticoagulation; CAS: carotid artery stenting; DAPT: dual antiplatelet therapy (eg, aspirin and clopidogrel, or aspirin and ticagrelor); NIHSS: National Institutes of Health Stroke Scale; CT: computed tomography; MRI: magnetic resonance imaging.
* Brain and neurovascular imaging, cardiac evaluation, and (for select patients) other laboratory tests.
¶ Indications for long-term oral anticoagulation include atrial fibrillation, ventricular thrombus, mechanical heart valve, and treatment of venous thromboembolism.
Δ "Large" infarcts are defined as those that involve more than one-third of the middle cerebral artery territory or more than one-half of the posterior cerebral artery territory based upon neuroimaging with CT or MRI. Though less reliable, large infarct size can also be defined clinically (eg, NIHSS score >15). ◊ Long-term aspirin therapy is alternative (though less effective) if OA contraindicated or refused.
§ Direct oral anticoagulant agents have a more rapid anticoagulant effect than warfarin, a factor that may influence the choice of agent and timing of OA initiation.
¥ Some experts prefer DAPT, based upon observational evidence.
‡ Long-term single-agent antiplatelet therapy for secondary stroke prevention with aspirin, clopidogrel, or aspirin-extended-release dipyridamole.
