Antiplatelet therapy for acute ischaemic stroke
Aspirin has a modest benefit when given within 48 hours of acute ischaemic stroke, and is routinely used. Do not give aspirin until brain imaging excludes intracranial haemorrhage. If the patient has received alteplase, withhold aspirin for 24 hours and do not start until follow-up imaging excludes haemorrhage.
If brain imaging has excluded intracranial haemorrhage, and within 48 hours of onset of ischaemic stroke, use:
aspirin 300 mg orally or via nasogastric tube or rectally, on the first day. Reduce dose to 100 mg daily on the second day and continue daily therapy indefinitely1. stroke, acute (adult) aspirin
It is reasonable to use another standard antiplatelet drug (eg clopidogrel) in patients who are allergic to aspirin, but no evidence supports their use in acute ischaemic stroke.