Antithrombotic And Thrombolytic Therapy For Ischemic Stroke
Publication Date: February 1, 2012
Last Updated: March 14, 2022
Recommendations
Acute Ischemic Stroke Treatment
In patients with acute ischemic stroke in whom treatment can be initiated within 3 h of symptom onset, we recommend IV r-tPA over no IV r-tPA. (1, A)
307795
In patients with acute ischemic stroke in whom treatment can be initiated within 4.5 h but not within 3 h of symptom onset, we suggest IV r-tPA over no IV r-tPA. (2, C)
307795
In patients with acute ischemic stroke in whom treatment cannot be initiated within 4.5 h of symptom onset, we recommend against IV r-tPA.
(1, B)307795
In patients with acute ischemic stroke due to proximal cerebral artery occlusions who do not meet eligibility criteria for treatment with IV r-tPA, we suggest intraarterial (IA) r-tPA initiated within 6 h of symptom onset over no IA r-tPA. (2, C)
307795
In patients with acute ischemic stroke we suggest IV r-tPA over the combination IV/IA r-tPA. (2, C)
307795
In patients with acute ischemic stroke, we suggest against the use of mechanical thrombectomy. (2, C)
307795
In patients with acute ischemic stroke or TIA, we recommend early (within 48 h) aspirin therapy at a dose of 160 to 325 mg over no aspirin therapy. (1, A)
307795
In patients with acute ischemic stroke or TIA, we recommend early (within 48 h) aspirin therapy with an initial dose of 160 to 325 mg over therapeutic parenteral anticoagulation. (1, A)
307795
VTE Prevention in Ischemic and Hemorrhagic Stroke
In patients with acute ischemic stroke and restricted mobility, we suggest prophylactic- dose subcutaneous heparin (UFH or LMWH) or intermittent pneumatic compression devices over no prophylaxis. (2, B)
307795
In patients with acute ischemic stroke and restricted mobility, we suggest prophylactic-dose LMWH over prophylactic-dose UFH. (2, B)
307795
In patients with acute stroke and restricted mobility, we suggest against elastic compression stockings. (2, B)
307795
In patients with acute primary intracerebral hemorrhage and restricted mobility, we suggest prophylactic-dose subcutaneous heparin (UFH or LMWH) started between days 2 and 4 or intermittent pneumatic compression devices over no prophylaxis. (2, C)
307795
In patients with acute primary intracerebral hemorrhage and restricted mobility, we suggest prophylactic-dose LMWH over prophylactic-dose UFH. (2, B)
307795
In patients with primary intracerebral hemorrhage and restricted mobility, we suggest against elastic compression stockings. (2, B)
307795
Secondary Stroke Prevention
In patients with a history of noncardioembolic ischemic stroke or TIA,
we recommend long-term treatment with aspirin (75-100 mg once daily), clopidogrel (75 mg once daily), aspirin/ extended release dipyridamole (25 mg/200 mg bid), or cilostazol (100 mg bid) over no antiplatelet therapy, (1, A)
307795
- the combination of clopidogrel plus aspirin
(1, B)307795
Of the recommended antiplatelet regimens,
we suggest clopidogrel or aspirin/extended-release dipyridamole over aspirin (2, B)
307795
In patients with a history of ischemic stroke or TIA and AF, including paroxysmal AF,
we recommend oral anticoagulation over no antithrombotic therapy, (1, A)
307795
- or combination therapy with aspirin and clopidogrel.
(1, B)307795
In patients with a history of ischemic stroke or TIA and AF, including paroxysmal AF, we suggest oral anticoagulation with dabigatran 150 mg bid over adjusted-dose VKA therapy (target INR range, 2.0 to 3.0). (2, B)
307795
In patients with a history of ischemic stroke or TIA and AF, including paroxysmal AF, who are unsuitable for or choose not to take an oral anticoagulant (for reasons other than concerns about major bleeding), we recommend combination therapy with aspirin and clopidogrel over aspirin. (1, B)
307795
In patients with a history of a symptomatic primary ICH, we suggest against the longterm use of antithrombotic therapy for the prevention of ischemic stroke. (2, C)
307795
Cerebral Venous Sinus Thrombosis
In patients with cerebral venous sinus thrombosis, we suggest anticoagulation over no anticoagulant therapy during the acute and chronic phases. (2, C)
307795
Title
Antithrombotic And Thrombolytic Therapy For Ischemic Stroke
Authoring Organization
American College of Chest Physicians
Publication Month/Year
February 1, 2012
Last Updated Month/Year
May 15, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
This article provides recommendations on the use of antithrombotic therapy in patients with stroke or transient ischemic attack (TIA).
Target Patient Population
Patients with stroke or transient ischemic attack (TIA).
Inclusion Criteria
Male, Female, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Outpatient, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Treatment, Management, Prevention
Diseases/Conditions (MeSH)
D000925 - Anticoagulants, D000991 - Antithrombins, D020521 - Stroke, D002546 - Ischemic Attack, Transient
Keywords
stroke, Stroke Prevention, Transient Ischemic Attack, Antithrombotic Agents, Acute Ischemic Stroke