Anticoagulants and antiplatelet agents in acute ischemic stroke: report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a division of the American Heart Association).

Stroke remains a common and costly problem worldwide, but substantial advances have been made in recent decades in understanding stroke mechanisms, risk factors, and therapies. Because thrombosis plays an important role in the pathogenesis of ischemic stroke, drugs that interfere with hemostasis and clot formation such as anticoagulants and platelet antiaggregants commonly are used in the management of cerebrovascular disease. Considerable evidence supports the use of certain antithrombotic drugs in stroke prevention. However, because of limited supportive data, the use of these agents in patients with acute ischemic stroke remains controversial. In this report, we examine the published evidence relevant to the effects of anticoagulants and antiplatelet agents on acute ischemic stroke mortality, morbidity, and recurrence rates as well as associated ancillary benefits and risks of those treatments on the rates of deep vein thrombosis, pulmonary embolus, and cardiovascular complications. As part of these analyses, we also sought to determine whether there was evidence supporting differential efficacy of these drugs according to ischemic stroke subtypes. To prepare this report, experienced neurologists with a special interest in stroke diagnosis and management were appointed by the Quality Standards Subcommittee (QSS) and the Therapeutics and Technology Assessment (TTA) Subcommittee of the American Academy of Neurology, and the Stroke Council and Science Advisory and Coordinating Committee (SACC) of the American Heart Association (AHA). The QSS, TTA, Stroke Council and SACC are each charged with the responsibility of preparing evidence-based reports pertaining to medical practice issues including stroke. To facilitate the process of joint guideline development, a Steering Committee, chaired by representatives of the AAN and the American Stroke Association of the AHA, was appointed to discuss potential topics of wide interest to the stroke community. Choosing the role of anticoagulants and antiplatelet agents in acute ischemic stroke as the first topic, a Joint Writing …

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