When selecting a thrombolytic, consider tenecteplase for its higher fibrin specificity and convenient single-bolus administration. Administer aspirin within forty-eight hours to decrease recurrent stroke risk, even in mild petechial hemorrhagic transformations. Conversely, avoid routine early heparin or anticoagulation in acute settings—including cardioembolic or progressing strokes—as they offer no proven benefit and significantly increase brain bleeding risks.

Tenecteplase features higher fibrin specificity and a longer half-life than alteplase.

Aspirin within forty-eight hours reduces recurrent stroke risk by one percent.

GP IIb/IIIa antagonists provide no added benefit and increase major bleeding risks.

Routine early heparin or anticoagulation does more harm than good in acute strokes.

Anticoagulation is contraindicated for large infarcts or NIHSS scores above fifteen.