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AHA/ASA Early Management of Acute Ischemic Stroke 2026

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51 5.4. Deep Vein Thrombosis Prophylaxis COR LOE Recommendations 1 B-R 1. In patients with AIS who have impaired mobility and do not have contraindications to intermittent pneumatic compression (IPC), IPC in addition to routine care is recommended over routine care alone to reduce the risk of deep vein thrombosis (DVT). 2a B-R 2. In patients with AIS who have impaired mobility, either prophylactic-dose subcutaneous heparin (UFH or LMWH) is reasonable to reduce the risk of VTE. 2b A 3. In patients with AIS who have impaired mobility, the benefit of prophylactic-dose subcutaneous heparin (UFH or LMWH) over no prophylactic-dose heparin is not well established to increase overall survival. 2b B-R 4. In patients with AIS who have impaired mobility and who are selected for prophylactic anticoagulation, the benefit of prophylactic-dose LMWH over prophylactic-dose UFH to prevent DVT is uncertain. 3: Harm B-R 5. In patients with AIS who have impaired mobility, elastic compression stockings cause harm, including skin breakdown, ulceration, and tissue necrosis, compared with usual care. 5.5. Depression COR LOE Recommendations 1 B-NR 1. In patients with AIS, administration of a structured depression inventory is recommended to routinely screen for poststroke depression (PSD), although the optimal timing of screening is uncertain. 1 B-R 2. In patients diagnosed with PSD, treatment with antidepressants and/or nonpharmacological interventions (ie, psychotherapy, noninvasive brain stimulation, acupuncture) is recommended to improve depressive symptoms.

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