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(Stroke. 2002;33:1934.)
© 2002 American Heart Association, Inc.

ASA/AAN Scientific Statement

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)

B.M. Coull, MD; L.S. Williams, MD; L.B. Goldstein, MD; J.F. Meschia, MD; D. Heitzman, MD; S. Chaturvedi, MD; K.C. Johnston, MD; S. Starkman, MD; L.B. Morgenstern, MD; J.L. Wilterdink, MD; S.R. Levine, MD J.L. Saver, MD

From the Department of Neurology (B.M.C.), Arizona Health Science Center, Tucson, Ariz; Department of Neurology (L.S.W.), Indiana University School of Medicine, Research Scientist, Regenstrief Institute for Health Care, Indianapolis, Ind; Department of Neurology (L.B.G.), Duke Center for Cerebrovascular Disease, Duke Center for Clinical Health Policy Research, and Durham VA Medical Center, Durham, NC; Department of Neurology (J.F.M.), Mayo Clinic/Jacksonville, Fla; Texas Neurology, PC (D.H.), Dallas, Tex; Department of Neurology (S.C.), Wayne State University, Detroit, Mich; Departments of Neurology and Health (K.C.J.), Evaluation Sciences, University of Virginia, Charlottesville; Departments of Emergency Medicine and Neurology (S.S.), UCLA, and Department of Neurology (J.L.S.), UCLA School of Medicine, Los Angeles, Calif; Departments of Neurology & Epidemiology (L.B.M.), University of Texas, Houston; Department of Clinical Neurosciences (J.L.W.), Brown Medical School, Providence, RI; and Department of Neurology (S.R.L.), Mount Sinai School of Medicine, New York, NY.

Correspondence and reprint requests to American Academy of Neurology, 1080 Montreal Ave., St. Paul, MN 55116.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

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.

Methods

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 . . . [Full Text of this Article]

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