Aspirin VS fibrinolytics in Ischemic stroke

[lordman]

What is the symptoms are within 4 hours (within the range of fibrinolytics), would you give asipirin or fibrinolytics? or Both?

I know that ASA is given within 24 hours.

---

Members don't see this ad.

 

[blaqmamba]

You basically answered the question yourself, lol. But the answer is yes, give both. The question is unlikely to ask you to give both or one, but you would give alteplase if within the window, and then ASA for antithrombotic therapy.

 

[lordman]

You basically answered the question yourself, lol. But the answer is yes, give both. The question is unlikely to ask you to give both or one, but you would give alteplase if within the window, and then ASA for antithrombotic therapy.

Thanks man. But shouldn't we d/c aspirin for 24 hours if we give alteplase? so if ASA was a choice and alteplase was another choice and symptoms have been for 4 hours, give alteplase only?

 

[blaqmamba]

Thanks man. But shouldn't we d/c aspirin for 24 hours if we give alteplase? so if ASA was a choice and alteplase was another choice and symptoms have been for 4 hours, give alteplase only?

[Sounds like you're choosing between 'alteplase only' and 'alteplase and ASA' - I would go with the latter, although alteplase should be given first. They work by different mechanisms. You could even make the question a bit more complicated by asking if the patient was previously on ASA.] - EDIT: wrong, you only give alteplase and hold ASA for 24h

Regardless, I would just know to give alteplase if within the window, and ASA regardless (but given after alteplase). Someone please correct me if I'm wrong.

From UpToDate: "A systematic review of antiplatelet therapy for acute stroke included 12 trials involving 43,041 patients, but the IST and CAST studies contributed 94 percent of the data. The reviewers concluded that starting ASA (160 to 300 mg daily) within 48 hours of presumed ischemic stroke onset reduced the risk of early recurrent ischemic stroke without a major risk of early hemorrhagic complications and improved long-term outcome."

 

[blaqmamba]

I just want to correct myself @lordman that you would not give ASA if giving tPA. You would start ASA after 24 hours like you (and UW) mentioned. Originally thought they worked by different mechanisms, but I guess you don't want to increase the chance of a bleed after tPA.

tPA if within window, hold ASA for 24h
ASA immediately (or at least within 48 hours), if not within window

Hope this helps.

 

[lordman]

Thank you. Yes, this is the point I want to hear! I only made this thread because of the UW idea of 24hrs thing of holding ASA when giving tPA. So wanted to hear if folks agree with this