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ASA in acute ischemic stroke has been studied in two large, randomized trials, the In-

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ternational Stroke Trial and the Chinese Acute Stroke Trial. ' Patients who received ASA within 24 to 48 hours of the onset of acute stroke symptoms were less likely to suffer early recurrent stroke, death, and disability. Early ASA therapy with an initial dose of 150 to 325 mg is recommended in most patients with acute ischemic stroke within 48 hours after stroke onset. The ASA dose may then be reduced to 50 to 100 mg daily to reduce bleeding complications.11

The administration of anticoagulants and antiplatelet agents should be delayed for 24 hours in those patients receiving alteplase. Clopidogrel either alone or in combination with ASA is not recommended in acute ischemic stroke. Glycoprotein IIb/IIIa

receptor inhibitors are not recommended except in the setting of research. Ancrod

Ancrod is an investigational agent that acts to decrease plasma fibrinogen levels. It may be beneficial in patients with acute ischemic stroke when administered within 3

hours of symptom onset. Based upon available clinical trials, ancrod appears to have a potential benefit; however, studies are ongoing. It is not recommended for clinical use

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because efficacy and safety have not been definitively established. PREVENTION OF ACUTE ISCHEMIC STROKE

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