20
Treatment
Antiplatelet Agents
Î Oral administration of aspirin (initial dose 325 mg) within 24-48 hours
after stroke onset is recommended for treatment of most patients (I-A).
Î The 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.
Î The 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.
Î Aspirin is NOT recommended as a substitute for other acute
interventions for treatment of stroke, including IV rtPA (III-B).
Î The administration of other IV antiplatelet agents that inhibit the
glycoprotein IIb/IIIa receptor is NOT recommended (III-B).
Note: Further research testing the usefulness of emergency administration of these
medications as a treatment option in patients with acute ischemic stroke is required.
Î The administration of aspirin (or other antiplatelet agents) as
an adjunctive therapy within 24 hours of IV fibrinolysis is NOT
recommended (III-C).
Volume Expansion, Vasodilators, and Induced Hypertension
Î In exceptional cases with systemic hypotension producing neurological
sequelae, a physician may prescribe vasopressors to improve cerebral
blood flow. If drug-induced hypertension is used, close neurological
and cardiac monitoring is recommended (I-C).
Î The administration of high-dose albumin is not well established as a
treatment for most patients with acute ischemic stroke until further
definitive evidence regarding efficacy becomes available (IIb-B).
Î At present, use of devices to augment cerebral blood flow for
the treatment of patients with acute ischemic stroke is not well
established (IIb-B).
Note: These devices should be used in the setting of clinical trials.
Î The usefulness of drug-induced hypertension in patients with acute
ischemic stroke is not well established (IIb-B).
Note: Induced hypertension should be performed in the setting of clinical trials.
Î Hemodilution by volume expansion is NOT recommended for
treatment of patients with acute ischemic stroke (III-A).
Î The administration of vasodilatory agents, such as pentoxifylline,
is NOT recommended for treatment of patients with acute ischemic
stroke (III-A).
