Antiplatelets

Aspirin

“The pooled results of 2 large trials in 1997 established the efficacy of aspirin in acute ischaemic stroke [32, 33]. The authors found 9 fewer deaths or non-fatal strokes per 1000 in the first few weeks, and 13 fewer dead or dependent patients per 1000 after follow-up.

Aspirin should be withheld for 24 hours in patients treated with tPA [1, 19].

Otherwise, it should be given (300mg) as soon as haemorrhage has been excluded, i.e. post-CT scan. It can be given orally if the patient’s swallow is unaffected; otherwise it can be given rectally or by enteral tube.

If the patient previously had dyspepsia with aspirin, a proton pump inhibitor should be co-administered.

If the patient is allergic to or intolerant of aspirin, they should be given an alternative antiplatelet agent (e.g. clopidogrel) [1].

Other antiplatelets

Some studies have suggested benefit from dual antiplatelet therapy [34]. This is not yet recommended by national stroke guidelines.