Ischaemic stroke: acute treatment outline
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Ischaemic stroke: acute treatment outline. Aspirin 75mg and Clopidogrel 300mg loading dose. Fully referenced neurology checklist.
Antiplatelets for minor stroke or high-risk TIA (ABCD2 ≥4)
- Aspirin 75mg and Clopidogrel 300mg loading dose
- Then Aspirin 75mg and Clopidogrel 75mg daily for 21 days
- Then Clopidogrel 75mg life-long
Antiplatelets for low-risk TIA (ABCD2 <4)
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Thrombolysis: for stroke with disabling symptoms
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Mechanical thrombectomy
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Anticoagulation
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Carotid endarterectomy (CEA)
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Management of malignant cerebral edema (MBE)
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Acute decompressive hemicraniectomy: indications
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Treatment of silent brain infarcts
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Investigational stroke treatments
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References
- Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49:e46-e110.
- Hurford R, Sekhar A, Hughes TAT, Muir KW. Diagnosis and management of acute ischaemic stroke. Pract Neurol 2020; 20:304-316.
- Powers WJ, Derdeyn CP, Biller J, et al; American Heart Association Stroke Council. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46:3020-3035.
- Palaniswami M, Yan B. Mechanical thrombectomy is now the gold standard for acute ischemic stroke: implications for routine clinical practice. Interv Neurol 2015; 4:18-29.
- Jo K, Bajgur SS, Kim H, Choi HA, Huh PW, Lee K. A simple prediction score system for malignant brain edema progression in large hemispheric infarction. PLoS One 2017; 12:e0171425.
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