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)
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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)
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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.
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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)
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In patients with acute ischemic stroke we suggest IV r-tPA over the combination IV/IA r-tPA. (2, C)
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In patients with acute ischemic stroke, we suggest against the use of mechanical thrombectomy. (2, C)
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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)
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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)
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Title
Antithrombotic And Thrombolytic Therapy For Ischemic Stroke
Authoring Organization
American College of Chest Physicians