Periprocedural antithrombotic medication in acute ischemic stroke treated by catheter-based thrombectomy. A review

This review summarized limited information known about periprocedural antithrombotic therapy before, during and immediately after percutaneous catheter-based thrombectomy for acute ischemic stroke. Very few data on this topic were published so far. In general, rtPA should be used upfront whenever clinically clearly indicated (0–3 h from stroke onset, absence of contraindications) irrespective of subsequent mechanical thrombectomy. If mechanical treatment follows after thrombolysis, neither anticoagulation, nor antiplatelet agents should be used in the acute phase. No data exist about the periprocedural use of anticoagulation or antiplatelet therapy in patients who cannot receive fibrinolysis and undergo direct mechanical thrombectomy alone. Most centers use no or very low dose heparin and a single dose of aspirin.