Tenecteplase offers a single-bolus administration advantage over alteplase. Aspirin should be initiated within 48 hours of ischemic stroke onset per IST and CAST trial evidence. Heparin is not recommended in acute ischemic stroke due to increased hemorrhage risk without net clinical benefit. Early anticoagulation in cardioembolic stroke (e.g., atrial fibrillation) within 48 hours increases symptomatic intracranial hemorrhage risk.

Tenecteplase has higher fibrin specificity and a longer half-life, allowing single-bolus dosing with comparable or superior vessel recanalization rates versus alteplase.Aspirin within 48 hours of ischemic stroke reduces recurrent stroke risk by approximately 1% per IST and CAST trials.GP2b/3a antagonists (e.g., abciximab) offer no benefit over aspirin and increase bleeding risk; not recommended.Petechial hemorrhagic transformation does not automatically preclude aspirin use, but initiation should await neurological stability.Heparin and LMWH are not recommended in acute ischemic stroke due to increased hemorrhage risk without net benefit.Early anticoagulation in cardioembolic stroke within 48 hours increases symptomatic intracranial hemorrhage without reducing recurrence.Contraindications to anticoagulation include large infarct, NIHSS above 15, uncontrolled hypertension, and active or prior bleeding.