Ischaemic stroke: acute treatment outline

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)

Thrombolysis: for stroke with disabling symptoms

Mechanical thrombectomy

Anticoagulation

Carotid endarterectomy (CEA)

Management of malignant cerebral edema (MBE)

Acute decompressive hemicraniectomy: indications

Treatment of silent brain infarcts

Investigational stroke treatments

References

1. 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. 
2. Hurford R, Sekhar A, Hughes TAT, Muir KW. Diagnosis and management of acute ischaemic stroke. Pract Neurol 2020; 20:304-316.
3. 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.
4. 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.
5. 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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