Antiplatelet therapy with aspirin in acute ischaemic stroke

Antiplatelet therapy with aspirin, started within 48 hr of an acute ischaemic stroke, is safe and effective, avoiding about 10 deaths and early recurrent strokes per 1,000 patients treated. The reduction in early recurrent ischaemic stroke is not offset by any significant increase in intracranial haemorrhage. Immediate antiplatelet therapy in acute ischaemic stroke also seems to be associated with better long-term functional outcome, reducing the proportion of patients dead or dependent 6 months after the stroke. Aspirin is the only antiplatelet agent which has been evaluated adequately in acute ischaemic stroke. In this setting a dose is required which is large enough to achieve rapid inhibition of thromboxane biosynthesis and around 160-300 mg is required. If the patient can swallow safely, aspirin can be administered by mouth, if not, then per rectum as a suppository.