Q: In patients who receive thrombolytic therapy for CVA, Aspirin can be started (select one)

A) After TPA dose
B) After 24 hours
C) After one week
D) Once Repeat CT scan shows no bleed
D) After ruling out microbleeds in MRI


Answer:  B

Aspirin/ASA (antiplatelet agents) should be held for first 24 hours after thrombolytic therapy in CVA.

ARTIS trial was stopped early due to higher symptomatic intracranial bleed in the intravenous aspirin group, and at 3 months, the favorable outcome was similar for both the aspirin and the no aspirin groups. 

Repeat CT scan and MRI may be sought after TPA in CVA patients, but they are not required to start ASA after 24 hours.


Reference: 

Zinkstok SM, Roos YB, ARTIS investigators. Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet 2012; 380:731.