Aspirin Use in Acute Ischemic Stroke Management

Evidence-Based Recommendations

• The American Heart Association/American Stroke Association recommends aspirin (160-300 mg) within 24-48 hours after acute ischemic stroke onset, with Class I, Level A evidence 1, 2
• For patients receiving IV thrombolysis (alteplase), aspirin is generally delayed until 24 hours post-thrombolysis, but may be considered earlier when concomitant conditions provide substantial benefit or withholding poses substantial risk 1, 2
• Aspirin should NOT be used as a substitute for mechanical thrombectomy in otherwise eligible patients (Class III: No Benefit) 2

Key Clinical Considerations

• Aspirin (300 mg) is not a contraindication for mechanical thrombectomy when given as standard acute stroke treatment (160-300 mg within 24-48 hours) 1, 2, 3
• The American College of Cardiology recommends higher aspirin doses (300-325 mg) for patients not already taking aspirin immediately before percutaneous coronary intervention, supporting the safety of this dose in the acute thrombectomy setting 4, 5