New Stroke Management Guidelines: A Quick and Easy Guide
Bret S. Stetka, MD, Helmi L. Lutsep, MD
Anticoagulation. Antiplatelet Agents Anticoagulation .

The Basics:

Urgent anticoagulation not recommended in acute ischemic stroke Urgent anticoagulation not recommended for noncerebrovascular conditions in the setting of strokeAnticoagulation with 24 hours of IV rtPA not recommended. Efficacy of thrombin inhibitors not well established in acute strokeThe Bottom Line: Trials have not yet provided indications for anticoagulation in acute stroke. Urgent anticoagulation is not recommended in acute ischemic stroke, nor is it for noncerebrovascular conditions in the setting of moderate-to-severe strokes due to an increased risk for intracerebral hemorrhage. Anticoagulation within 24 hours of IV rtPA administration is also not recommended.

New: The usefulness of argatroban and other thrombin inhibitors in acute ischemic stroke is not well established at the time of guideline publication, nor is the usefulness of anticoagulating patients with severe stenosis of an internal carotid artery ipsilateral to an ischemic stroke.Antiplatelet Agents

The Basics:
Aspirin within 24-48 hoursOther antiplatelet agents not recommended

The Bottom Line: Aspirin remains the only antiplatelet agent for which data support use in acute stroke, although trials with other agents are in progress.Oral aspirin is recommended for most patients within 24-48 hours of initial symptoms; however, it is not a suitable substitute for other acute stroke interventions, including rtPA.

Revised: Clopidogrel’s usefulness is not well established, and the use of IV antiplatelet drugs that inhibit the glycoprotein IIb/IIIa receptor is not recommended. Adjunctive aspirin, or other antiplatelet therapies, within 24 hours of IV fibrinolysis are also not recommended.

New: The efficacy of glycoprotein IIb/IIIa inhibitors tirofiban and eptifibatide is not well-established.

PS This is a long article, I have just focussed on the anticoagulation aspect of treatment.