Antiplatelet Therapy for AF-Related Ischemic Stroke

Acute Phase Management

• The American College of Chest Physicians recommends aspirin 160-325 mg daily for acute stroke management, but not as bridging therapy, to reduce early recurrent stroke and improve outcomes in the acute phase 1
• The American College of Chest Physicians suggests that heparinoids should not be used as bridging therapy in acute AF-related stroke, as they increase symptomatic intracranial hemorrhage risk without net benefit 2
• Very early anticoagulation with warfarin or DOACs should be avoided due to increased hemorrhagic transformation risk 2

Transition to Anticoagulation

• Oral anticoagulation should typically be initiated within 2 weeks of stroke, with exact timing based on stroke severity, and antiplatelet therapy should be discontinued once oral anticoagulation is started 2

Special Circumstances Requiring Dual Therapy

• The American College of Chest Physicians recommends using triple therapy (OAC + aspirin + clopidogrel) for 1-3 months, then dual therapy (OAC + clopidogrel) up to 12 months based on bleeding risk, in patients with recent ACS or recent PCI/stenting 2, 5, 6
• If aspirin must be combined with OAC, low-dose aspirin 75-100 mg daily with PPI for GI protection is recommended 2, 5

VTE Prophylaxis During Immobilization

• Prophylactic anticoagulation for immobility is different from therapeutic anticoagulation, and prophylactic-dose LMWH or intermittent pneumatic compression should be used for immobilized stroke patients starting 2-4 days post-stroke 1, 4, 7