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Updated: Jul 3, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Antiplatelet therapy for acute ischaemic stroke
Peter A G Sandercock1, Carl Counsell, Gordon J Gubitz
1Department of Clinical Neurosciences, University of Edinburgh, Neurosciences Trials Unit, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU. peter.sandercock@ed.ac.uk
The Cochrane Database of Systematic Reviews
|July 23, 2008
Summary
Early antiplatelet therapy for acute ischemic stroke significantly reduces death or disability. Aspirin treatment, started within 48 hours, improves long-term outcomes with manageable risks of bleeding.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Platelet activation is common in acute ischemic stroke.
- Antiplatelet therapy may reduce brain damage and early stroke recurrence.
- Potential risks include fatal or disabling intracranial hemorrhage.
Purpose of the Study:
- To evaluate the efficacy and safety of antiplatelet therapy in acute ischemic stroke patients.
- To assess the impact on mortality, dependency, and hemorrhage risk.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) comparing antiplatelet therapy with control.
- Searched multiple databases including Cochrane, MEDLINE, and EMBASE up to June 2007.
- Included 12 trials with 43,041 participants, focusing on trials starting treatment within 14 days of stroke onset.
Main Results:
- A significant reduction in death or dependency was observed (OR 0.95, 95% CI 0.91 to 0.99).
- For every 1000 patients treated, 13 avoided death or dependency (NNT: 79).
- A small excess of symptomatic intracranial hemorrhages was noted, but outweighed by reduced recurrent strokes and pulmonary emboli.
Conclusions:
- Early antiplatelet therapy (aspirin 160-300 mg daily within 48 hours) improves long-term outcomes in acute ischemic stroke.
- This therapy reduces the risk of early recurrent ischemic stroke.
- The benefits outweigh the risks of early hemorrhagic complications.
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