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Antithrombotic treatment of acute ischemic stroke and transient ischemic attack

Jamary Oliveira Filho, MD, MS, PhD
Michael T Mullen, MD
Section Editor
Scott E Kasner, MD
Deputy Editor
John F Dashe, MD, PhD


The management of patients with acute ischemic stroke involves several phases (see "Initial assessment and management of acute stroke"). The goals in the initial phase include:

Insuring medical stability

Determining eligibility for thrombolytic therapy (table 1)

Moving toward uncovering the pathophysiologic basis of the stroke

Timely restoration of blood flow using thrombolytic therapy, including intravenous tissue plasminogen activator (tPA) and mechanical thrombectomy, is the most effective maneuver for salvaging ischemic brain tissue that is not already infarcted. There is a narrow window during which this can be accomplished, up to 4.5 hours after symptom onset for tPA and up to 6 hours for mechanical thrombectomy. Recommendations for patients able to receive thrombolytic therapy are found elsewhere. (See "Intravenous fibrinolytic (thrombolytic) therapy in acute ischemic stroke: Therapeutic use" and "Reperfusion therapy for acute ischemic stroke".)


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Literature review current through: Sep 2016. | This topic last updated: Jul 20, 2016.
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