Subacute Ischemic Stroke Management

Antiplatelet Therapy for Secondary Prevention

The American Heart Association recommends initiating aspirin 160-325 mg daily to reduce recurrent ischemic stroke, death, and dependency in patients with subacute ischemic stroke 1, 2
The American College of Cardiology advises against using glycoprotein IIb/IIIa inhibitors due to increased mortality without benefit in patients with subacute ischemic stroke 2, 3

The American Heart Association suggests avoiding aggressive blood pressure lowering in the subacute phase, particularly in watershed or hypoperfusion-related strokes, to maintain adequate perfusion pressure 4
The American College of Cardiology recommends only treating blood pressure if systolic >220 mmHg or diastolic >120 mmHg in most patients not receiving thrombolysis 5, 6

The American Heart Association recommends admitting all patients to a geographically defined stroke unit with specialized interdisciplinary staff to improve mortality and functional outcomes 4, 6
The American College of Cardiology advises performing swallowing assessment before allowing any oral intake to prevent aspiration pneumonia in patients with subacute ischemic stroke 4, 6

The American College of Cardiology recommends initiating high-intensity statin therapy regardless of baseline cholesterol levels in patients with subacute ischemic stroke 4
The American Heart Association suggests evaluating for carotid stenosis and performing urgent carotid revascularization (endarterectomy or stenting) within 2 weeks if ≥70% symptomatic stenosis is identified 4

The American Heart Association advises against aggressively lowering blood pressure in watershed or hemodynamic strokes, as these result from hypoperfusion and require adequate perfusion pressure 4
The American College of Cardiology recommends against using routine therapeutic anticoagulation in acute non-cardioembolic stroke, as it increases hemorrhagic risk without proven benefit 4, 6
The American Heart Association suggests avoiding volume expansion, vasodilators, or induced hypertension strategies outside clinical trials, as they are associated with serious complications without established benefit 2, 3