AIS Antithrombotic treatment

Posted On July 25, 2021

Acute ischemic stroke (AIS) & Transient ischemic attack (TIA)

Low risk TIA
- ABCD2 score < 4
- Aspirin 325 mg now and qd
High risk TIA
- ABCD2 score > or = 4
- Use dual antiplatelet therapy (DAPT)
  - Aspirin 325 mg + Clopidogrel 300 mg loading dose
  - then Aspirin 81 mg + Clopidogrel 75 mg qd for 21 days
- then single antiplatelet treatment
AIS, minor
- NIHSS < or = 5
- DAPT as above
AIS, moderate or high severity,
- NIHSS > 5
- Evaluate for tpa and intervention therapy, if not a candidate
- Aspirin 325 mg po qd or 300 mg suppository
Intracranial large artery stenosis
- DAPT as above for 90 days
For patients who were already on anticogulation
- TIA: may restart anticoagulation
- Minor AIS: restart after 3 days
- Moderate AIS: restart after 6 days
- Severe AIS: restart after 12 days
- Recommend repeat CT head to rule out bleed before restarting anticoagulation.