Antithrombotic strategy in stroke

Numerous randomised controlled trials have been devoted to antithrombotic s trategy in stroke, thus making evidence-based recommendations possible. The use of antithrombotic drugs is crucial in the treatment of ischemic stroke though often limited by the inherent risk of intra-cerebral bleeding. In t he prevention of stroke, the strategy depends on the underlying etiology: ( i) antiplatelet drugs (with aspirin as first choice) in atherothrombotic st roke, and (ii) oral anticoagulants in cardioembolic stroke. In the acute tr eatment, the strategy depends on whether IV rt-PA can be performed; if rt-P A is available and approved, its use is recommended within 3 h of the onset of symptoms provided there is strict adherence to the inclusion and exclus ion criteria. In all other cases, aspirin is the treatment of choice, assoc iated with low dose LMWH in the event of restricted mobility. There is no e vidence for efficacy of high dose heparin (or LMWH) in stroke, except in ce rebral venous thrombosis.