ÎÎThe usefulness of emergent intracranial angioplasty and/or stenting is
not well established. (IIb-C).
These procedures should be used in the setting of clinical trials.
ÎÎThe usefulness of emergent angioplasty and/or stenting of the
extracranial carotid or vertebral arteries in unselected patients is not
well established (IIb-C).
• Use of these techniques may be considered in certain circumstances, such as in
the treatment of acute ischemic stroke resulting from cervical atherosclerosis or
dissection (IIb-C).
Note: Additional randomized trial data are needed.
Anticoagulants
ÎÎAt present, the usefulness of argatroban or other thrombin inhibitors
for treatment of patients with acute ischemic stroke is not well
established (IIb-B).
Note: These agents should be used in the setting of clinical trials.
ÎÎThe usefulness of urgent anticoagulation in patients with severe
stenosis of an internal carotid artery ipsilateral to an ischemic stroke
is not well established (IIb-B).
ÎÎUrgent anticoagulation, with the goal of preventing early recurrent
stroke, halting neurological worsening, or improving outcomes after
acute ischemic stroke, is NOT recommended for treatment of patients
with acute ischemic stroke (III-A).
ÎÎUrgent anticoagulation for the management of noncerebrovascular
conditions is NOT recommended for patients with moderate-tosevere strokes because of an increased risk of serious intracranial
hemorrhagic complications (III-A).
ÎÎInitiation of anticoagulant therapy within 24 hours of treatment with
IV rtPA is NOT recommended (III-B).
Antiplatelet Agents
ÎÎOral administration of aspirin (initial dose 325 mg) within 24-48 hours
after stroke onset is recommended for treatment of most patients
(I-A).
ÎÎThe usefulness of clopidogrel for the treatment of acute ischemic
stroke is not well established (IIb-C).
Note: Further research testing the usefulness of the emergency administration of
clopidogrel in the treatment of patients with acute stroke is required.
ÎÎThe efficacy of IV tirofiban and eptifibatide is not well established.
(IIb-C).
Note: These agents should be used only in the setting of clinical trials.
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