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General Supportive Early Management
4.8. Antiplatelet Treatment
COR LOE
Recommendations
General Principles for Early Antiplatelet erapy
1 A
1. In patients with AIS, administration of aspirin is
recommended within 48 hours after stroke onset to reduce
risk of death and dependency.
2b B-NR
2. In patients with AIS who have received IVT, the risk of
antiplatelet therapy in the first 24 hours after IVT (with or
without mechanical thrombectomy) is uncertain. Use might
be considered in the presence of concomitant conditions for
which such treatment given in the absence of IVT is known
to provide substantial benefit or when withholding such
treatment is known to cause substantial risk.
2b B-R
3. In patients with AIS, the efficacy of IV tirofiban to improve
clinical outcomes is not well established.
3: Harm B-R
4. In patients with AIS, the administration of IV abciximab is
not recommended due to increased bleeding complications.
Early Secondary Prevention
1 A
5. In patients with noncardioembolic AIS or TIA, antiplatelet
therapy is indicated in preference to oral anticoagulation
to reduce the risk of recurrent ischemic stroke and other
cardiovascular events, while minimizing the risk of bleeding.
1 C-EO
6. In patients with noncardioembolic AIS or TIA, the selection
of an antiplatelet agent for early secondary stroke prevention
should be individualized on the basis of patient risk factor
profiles, cost, tolerance, relative known efficacy of the agents,
and other clinical characteristics.
2a B-R
7. In patients with AIS and extracranial carotid or vertebral
arterial dissection, treatment with either antiplatelet or
anticoagulant therapy for at least 3 months is reasonable to
prevent recurrent stroke.
2b B-NR
8. For patients already taking aspirin at the time of
noncardioembolic ischemic stroke or TIA, the effectiveness
of increasing the dose of aspirin or changing to another
antiplatelet medication is not well established.
3: No
benefit
B-R
9. In patients with minor (NIHSS score ≤3) noncardioembolic
AIS or high-risk TIA (ABCD2 score ≥4), ticagrelor is not
recommended over aspirin to reduce the composite endpoint
of stroke, myocardial infarction, or death.
