Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

“…In addition to the dilemma of the sequence of management, the agents of management for each territory may complicate the extent of the other infarcted territory. Antiplatelet therapy (3,24,25), GPIIa/IIIb inhibitors (26) and anticoagulants (4) used in coronary intervention for AMI increase the risk for hemorrhagic conversion of AIS associated with thrombolytic, and the use of a thrombolytic in AIS increases the risk of cardiac wall rupture in setting of AMI (5). There are no clinical trials that have addressed this dilemma likely due to its rarity, and there are also no evidenced-based societal guidelines on the sequence of approach to management.…”

“…Both conditions have a narrow therapeutic time-window, such that acute management of one at the expense of the other may result in permanent irreversible disability from the infarcted area that received delayed intervention. In addition, the use of antiplatelet and anticoagulants that are inherently part of a percutaneous coronary intervention (PCI) for AMI may increase the risk for hemorrhagic conversion associated with intravenous thrombolysis (3,4), and the use of a thrombolytic in AIS increases the risk of cardiac wall rupture in the setting of AMI (5). In fact, according to the guidelines for the early management of patients with AIS, AMI within the past 3 months is considered a relative contraindication to the use of a thrombolytic (Class IIb, level of evidence C) (6).…”

The Therapeutic Strategy and Outcome of Endovascular Therapy for Acute Stroke with Cerebral Proximal Artery Occlusion due to Atherosclerotic Artery Stenosis

“…They suggested a significantly lower National Institute of Health Stroke Scale (NIHSS) score and a significantly higher effective recanalization rate as reasons for this difference and speculated that these patients might have a except for the use of heparin at ≤10000 units for angiography or the prevention of deep venous thrombosis. 14,15) However, antiplatelet agents are considered essential in CAS or for the prevention of thrombus formation at sites of stenosis. As the outcome is exacerbated by hemorrhage, even if recanalization can be achieved, we used antiplatelet agents after confirming the narrowness of the infarct area by pretreatment MRI and maintained the blood pressure low after treatment, 16) to avoid hemorrhagic complications.…”

Combining Intravenous Thrombolysis and Antithrombotic Agents in Stroke: An Update

“…This is the only antithrombotic agent that has proven to be effective at preventing early ischemic recurrence and at improving the prognosis for cerebral infarction. A randomized open phase 3 study, called ARTIS (Antiplatelet Therapy in Combination with RT‐PA Thrombolysis in Ischemic Stroke), has evaluated the potential of a treatment associating 0.9 mg/kg of rtPA administered intravenously within 4.5 hours of the onset of stroke and 300 mg of aspirin administered as an intravenous bolus within 90 minutes of initiating the thrombolysis, as compared with a conventional intravenous thrombolysis 10. Between July 2008 and April 2011, 642 patients were recruited at several Dutch hospital centers.…”