Antithrombotic treatment of acute ischemic stroke and transient ischemic attack
- Jamary Oliveira Filho, MD, MS, PhD
Jamary Oliveira Filho, MD, MS, PhD
- Associate Professor of Neuroanatomy
- Federal University of Bahia
- Director, Neurocritical Care Unit
- Hospital Santa Izabel, Brazil
- Michael T Mullen, MD
Michael T Mullen, MD
- Assistant Professor of Neurology
- University of Pennsylvania School of Medicine
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".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- ANTIPLATELET AGENTS
- Combination antiplatelets
- Choosing early antiplatelet therapy
- PARENTERAL ANTICOAGULATION
- Stroke subtypes
- - Atrial fibrillation and cardioembolic stroke
- Progressing stroke
- Role of early anticoagulation
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS