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Anticoagulants and
antiplatelet agents in acute ischemic stroke
Report of the Joint Stroke Guideline Development Committee of the
American Academy of Neurology and the American Stroke Association (a
Division of the American Heart Association)
Neurology. July 2002
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here to read original article)
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 | Patients with acute ischemic stroke presenting
within 48 hours of symptom onset should be given aspirin (160 to 325
mg/day), provided contraindications such as allergy and gastrointestinal
bleeding are absent, and the patient has or will not be treated with
TPA.
 | The data are insufficient at this time to
recommend the use of any other platelet antiaggregant in the setting of
acute ischemic stroke. |
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| Subcutaneous
unfractionated heparin, LMW heparins, and heparinoids may be considered
for DVT prophylaxis in at-risk patients with acute ischemic stroke,
recognizing that nonpharmacologic treatments for DVT prevention also
exist. A benefit in reducing the incidence of PE has not been
demonstrated. The relative benefits of these agents must be weighed
against the risk of systemic and intracerebral hemorrhage.
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| There is some
evidence that fixed-dose, subcutaneous, unfractionated heparin reduces
early recurrent ischemic stroke, this benefit is negated by a concomitant
increase in the occurrence of hemorrhage. Therefore, use of subcutaneous
unfractionated heparin is not recommended for decreasing the risk of death
or stroke-related morbidity or for preventing early stroke recurrence.
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| Dose-adjusted, unfractionated heparin is not
recommended for reducing morbidity, mortality, or early recurrent stroke
in patients with acute stroke (i.e., in the first 48 hours) because the
evidence indicates it is not efficacious and may be associated with
increased bleeding complications. |
| High-dose LMW heparin/heparinoids have not been
associated with either benefit or harm in reducing morbidity, mortality,
or early recurrent stroke in patients with acute stroke and are,
therefore, not recommended for these goals. |
| IV, unfractionated heparin or high-dose LMW
heparin/heparinoids are not recommended for any specific subgroup of
patients with acute ischemic stroke that is based on any presumed stroke
mechanism or location (e.g., cardioembolic, large vessel atherosclerotic,
vertebrobasilar, or "progressing" stroke) because data are insufficient.
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| Although the LMW heparin, dalteparin, at high
doses may be efficacious in patients with atrial fibrillation, it is not
more efficacious than aspirin in this setting. Because aspirin is easier
to administer, it, rather than dalteparin, is recommended for the various
stroke subgroups. |
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