Management of acute ischemic stroke - What is the role of tPA and antithrombotic agents?

Every patient with acute stroke who presents to a medical center that has a ppropriate resources should undergo evaluation for intravenous tPA therapy. Such therapy should not be given unless the patient meets strict eligibili ty criteria based on clinical, radiographic, and laboratory data. Intra-art erial thrombolysis may be a promising alternative to intravenous tPA therap y, but it should still be regarded as experimental. Daily aspirin therapy s hould be initiated immediately in most patients who do not receive intraven ous tPA therapy and after 24 hours in most patients who receive this treatm ent. Measures should be taken to prevent medical complications, such as asp iration pneumonia, deep vein thrombosis, contractures, and pressure sores. Early initiation of rehabilitation can maximize stroke recovery. Whenever f easible, institutions should have stroke teams or units to streamline care and provide expertise for patients with acute stroke.