aspirin in acute stroke

Last edited 06/2019 and last reviewed 04/2020

A combined analysis of the results of the International Stroke Trial and the Chinese Acute Stroke Trial suggested that early death, recurrent stroke or late death can be prevented in 1 patient with acute stroke by giving aspirin to 100 patients with acute stroke.

NICE advise that all people presenting with acute stroke who have had a diagnosis of primary intracerebral haemorrhage excluded by brain imaging should, as soon as possible but certainly within 24 hours, be treated with aspirin:

  • aspirin 300 mg orally if they are not dysphagic or
  • aspirin 300 mg rectally or by enteral tube if they are dysphagic

Thereafter, aspirin 300 mg should be continued until 2 weeks after the onset of stroke symptoms, at which time definitive long-term antithrombotic treatment should be initiated.

Patients being discharged before 2 weeks can be started on long-term treatment earlier.

If there is a history of dyspepsia associated with aspirin then combination therapy with a proton pump inhibitor is recommended.

If the patient is allergic or intolerant of aspirin then an alternative antiplatelet agent, such as clopidogrel or dipyridamole, should be given.

Anticoagulation, with for example heparin, should is not routinely indicated for the treatment of acute stroke.

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