Acute antithrombotic therapy

Antithrombotic therapies include the use of antiplatelets and anticoagulants.

Antiplatelet agents inhibit platelet adhesion and aggregation, and anticoagulants reduce the propagation of a thrombus in an intracerebral artery. Therefore early use of antithrombotics may, theoretically, decrease the volume of infarcted cerebral tissue and so decrease the neurological deficit, risk of disability and death. Additionally, they may reduce the risk of early recurrent thromboembolic stroke. However, these benefits could be offset by the possibility of increased risk for intracerebral haemorrhage.

Common anticoagulant agents include unfractionated heparin, low-molecular-weight heparins, heparinoids, and oral vitamin K antagonists. The most commonly used antiplatelet agent in Australia is aspirin (acetylsalicylic acid). Clopidogrel and dipyridamole are also used by itself or in combination with aspirin.

In Australia, the National Stroke Audit of Acute Services showed that 76% of stroke patients received hyperacute aspirin therapy and 70% of ischaemic stroke patients received aspirin within 48 hours of admission.

For current research and evidence-based recommendations see our Clinical Guidelines.