Antiplatelets and anticoagulants have well defined role in the primary and secondary prevention of stroke. There is considerable variation in practice regarding the use of these agents independently or in combination in the acute phase of stroke. Systematic reviews like those in the Cochrane Library and evidence based guidelines help us in everyday decision making. Aspirin can be safely administered in acute ischemic stroke. If thrombolysis is performed, antiplatelets or anticoagulants should not be given in the next 24 hours. High dose intravenous or subcutaneous treatment with anticoagulants did not result in net benefit in acute stroke: the decrease in recurrent strokes was offset by hemorrhagic complications. Low dose anticoagulants – preferably low-molecular-weight heparins – may be recommended for those with high risk of deep vein thrombosis and consequent pulmonary embolism. Future trials will decide if there is any role for combined antiplatelet and/or anticoagulant treatment in any subtypes of acute ischemic stroke.
Keywords: stroke, antiplatelets, anticoagulants, systematic reviews, guidelines