CHEST Guidelines-Antithrombotic-and-Thrombolytic-Therapy-for-Ischem

Antithrombotic-and-Thrombolytic-Therapy-for-Ischem

Pdf Summary

The 9th edition ACCP Guidelines for antithrombotic therapy and prevention of thrombosis provide comprehensive recommendations for managing patients with stroke or transient ischemic attack (TIA). These guidelines address several key areas based on varying levels of evidence.<br /><br />For acute ischemic stroke, immediate treatment with intravenous recombinant tissue plasminogen activator (r-tPA) is recommended if initiated within 3 hours of symptom onset, with a possible extension to 4.5 hours under specific conditions. Aspirin is advised early (within 48 hours) to improve outcomes, while prophylactic-dose heparin or intermittent pneumatic compression devices are suggested for patients with restricted mobility to prevent venous thromboembolism (VTE).<br /><br />The guidelines recommend long-term use of antiplatelet agents such as aspirin, clopidogrel, or the aspirin/extended-release dipyridamole combination for secondary prevention in patients with a history of noncardioembolic ischemic stroke or TIA. Clopidogrel or dipyridamole plus aspirin is favored over aspirin alone for better efficacy in preventing recurrent events.<br /><br />Patients with a history of stroke or TIA and atrial fibrillation (AF) should receive oral anticoagulation therapy because it substantially reduces the risk of recurrent stroke compared to antiplatelet therapy. The timing of anticoagulation initiation is crucial, typically within 1 to 2 weeks post-stroke, considering bleeding risks.<br /><br />Special considerations are made for patients with primary intracerebral hemorrhage (ICH), suggesting against routine use of long-term antithrombotic therapy for ischemic stroke prevention due to the high bleeding risk. However, it may be considered for those at a high risk of cardiac thromboembolic events.<br /><br />The guidelines also consider cerebral venous sinus thrombosis, where anticoagulation is suggested even in cases with hemorrhage, due to its potential benefit in preventing thrombosis progression.<br /><br />Overall, these guidelines emphasize personalized treatment plans based on careful evaluation of benefits versus risks, utilizing available clinical evidence to guide therapy choices for preventing secondary thrombotic events in stroke patients.

Keywords

ACCP Guidelines

antithrombotic therapy

stroke management

transient ischemic attack

intravenous r-tPA

antiplatelet agents

oral anticoagulation

cerebral venous sinus thrombosis

secondary prevention

personalized treatment