Aspirin Administration After Thrombectomy for Acute Ischemic Stroke

Patient Selection and Timing

• For patients who received IV thrombolysis, delay aspirin for 24 hours after tPA administration, with brain imaging to exclude intracranial hemorrhage before initiation, as recommended by the American Heart Association and American Stroke Association 1, 2
• For patients who had thrombectomy alone, start aspirin immediately after thrombectomy, once brain imaging excludes hemorrhage, with a loading dose of at least 160 mg aspirin 1, 3

Aspirin Dosage and Administration

• Administer a loading dose of at least 160 mg aspirin, followed by a maintenance dose of 81-325 mg daily indefinitely for secondary stroke prevention, as recommended by the Canadian Stroke Best Practice guidelines 1, 3, 4
• Use non-enteric coated aspirin formulations for rapid platelet inhibition 3

Imaging and Monitoring

• Obtain a 24-hour post-thrombolysis CT scan to exclude intracranial hemorrhage before starting aspirin, as recommended by the International Journal of Stroke 1, 2
• Do not skip the 24-hour post-thrombolysis imaging, as hemorrhage must be excluded before starting any antiplatelet therapy 1, 2

Special Considerations

• The American Heart Association and American Stroke Association recommend a 24-hour delay in aspirin administration after tPA to minimize bleeding complications, based on Level A and B evidence from major stroke trials 1, 2
• For patients with dysphagia, alternative routes for aspirin administration include enteral tube (80 mg daily) or rectal suppository (325 mg daily) 1, 3