Early Anticoagulation, DAPT for large-vessel diseas and Thrombectomy
This resource examines acute ischemic stroke protocols, highlighting the restricted benefits of short-course dual antiplatelet therapy and specifying eligibility criteria for mechanical thrombectomy in late-presenting patients.
Duration
00:03:21
File size
1.76 MB
Practitioner-Guided Note
When managing acute ischemic stroke, avoid routine early anticoagulation unless treating specific etiologies like mechanical valves or dissection. For minor stroke or TIA, initiate DAPT promptly, noting that benefits are highly concentrated within the first three weeks. For late arrivals (6–24 hours), determine thrombectomy eligibility by confirming a clinical-imaging mismatch using CT perfusion or diffusion-weighted MRI.
Key Takeaways
Early acute anticoagulation lacks routine benefit, barring exceptions like arterial dissection.
Ticagrelor combined with aspirin serves as a newer DAPT approach for large-vessel disease.
CHANCE trial DAPT benefits are heavily concentrated within the first three weeks post-onset.
Late thrombectomy (6–24 hours) requires a documented clinical-imaging mismatch.
Infarcts exceeding one-third of the MCA territory exclude patients from late thrombectomy.