[Antithrombotic therapy for ischemic cerebrovascular accident]

Antithrombotic therapy should be considered in the acute phase of an ischaemic stroke in patients who are not candidates for thrombolysis. The recommended treatment is aspirin, 160 or 300 mg daily, associated in bed-ridden patients with prophylactic heparin therapy to avoid venous thromboembolic complications. Although not founded on scientific proof, high dose anticoagulants may be used instead of aspirin in special cases presumed to be at high risk of early recurrence of embolism or of extension of thrombosis. Secondary prevention in patients who have already suffered a non-embolic ischaemic stroke is based mainly on antiplatelet drugs. Aspirin, clopidogrel or the association of aspirin and dipyridamole are possible first the options. Ticlopidine is not recommended as treatment of first intention because of its secondary effects and the necessity of monitoring the blood count. Oral anticoagulants are not recommended after a non-cardio-embolic ischaemic stroke except in special cases (e.g. deficit in inhibitors of blood clotting). Secondary prevention in patients at high cardio-embolic risk (e.g. atrial fibrillation) should be based on oral anticoagulants. Cardiac disease carrying a low or uncertain risk (e.g. patent foramen ovale without an atrial septal aneurysm) is usually treated with platelet inhibitors.