Management of Acute Ischemic Stroke: A Review of Pertinent Guideline Updates

Carley E. DeVee, PharmD, BCPS; Ryan J. Sangiovanni, PharmD


US Pharmacist. 2019;44(2):HS2-HS5. 

In This Article

Abstract and Introduction


In January 2018 the American Heart Association/American Stroke Association published a guideline outlining evidenced-based literature updates and optimal treatment for early management of patients with acute ischemic stroke (AIS). Among the recommendations, the guidelines expand and clarify thrombolytic treatment with IV alteplase and discuss timing of administration. Aspirin is reaffirmed as the drug of choice for antiplatelet treatment of AIS, and recommendations regarding dual antiplatelet therapy for secondary prophylaxis are updated. The new guidelines continue to reference no benefit in using anticoagulation for the treatment of AIS. Statin use, blood pressure, and blood glucose are discussed. Screening for depression in AIS patients is newly recommended.


There have been significant evidence-based literature updates regarding the management of acute ischemic stroke (AIS) in adult patients since the publication of the 2013 American Heart Association/American Stroke Association (AHA/ASA) guidelines.[1] In January 2018 the AHA/ASA published a guideline outlining these changes and optimal treatment for early management of patients with ischemic stroke.[2] This article reviews updates to thrombolytic, antiplatelet, and anticoagulation therapies, statin use, blood pressure and blood glucose targets, and a new recommendation for depression screening.