* The following is taken from the NZ Formulary
Alteplase is recommended in the treatment of acute ischaemic stroke if it can be administered within 4.5 hours of symptom onset; it should be given by medical staff experienced in the administration of thrombolytics and the treatment of acute stroke, preferably within a specialist stroke centre. Treatment with aspirin 300 mg once daily for 14 days should be initiated 24 hours after thrombolysis (or as soon as possible within 48 hours of symptom onset in patients not receiving thrombolysis); patients with aspirin hypersensitivity, or those intolerant of aspirin despite the addition of a proton pump inhibitor, should receive clopidogrel 75 mg once daily [unapproved indication] as an alternative.
Anticoagulants are not recommended as an alternative to antiplatelet drugs in acute ischaemic stroke in patients who are in sinus rhythm. However, parenteral anticoagulants may be indicated in patients who are symptomatic of, or at high risk of developing, deep vein thrombosis or pulmonary embolism; warfarin should not be commenced in the acute phase of ischaemic stroke.
Anticoagulation therapy for long-term secondary prevention should be used in all people with ischaemic stroke or TIA who have atrial fibrillation or cardioembolic stroke and no contra-indication. In acute ischaemic stroke, the decision to commence anticoagulation therapy can be delayed for up to two weeks but should be made prior to discharge. Patients already receiving anticoagulation for a prosthetic heart valve who experience a disabling ischaemic stroke and are at significant risk of haemorrhagic transformation, should have their anticoagulant treatment stopped for 7 days and substituted with aspirin 300 mg once daily.
Treatment of hypertension in the acute phase of ischaemic stroke can result in reduced cerebral perfusion, and should therefore only be instituted in the event of a hypertensive emergency or in those patients considered for thrombolysis.
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