Korean Journal of Clinical Pharmacy

Table. 4.

Table. 4. Table 4

Comparison of Korean Clinical Practice Guideline for Stoke (KCPGS) for antiplatelet treatment before and after revision and comparison with AHA/ASA guidelines

Previous KCPGS of 2009	Current KCPGS of 2022^a	Change	AHA/ASA Guidelines of 2019
1. In the hemorrhage-excluded, acute ischemic stroke patients, the oral administration of aspirin should start within 24 to 48 hours of onset (the loading dose 160–300 mg) (LOE: Ia, GOR: A)	1. In the hemorrhage-excluded, acute ischemic stroke patients, the oral administration of aspirin should start within 24 to 48 hours of onset (the loading dose 160–300 mg) (LOE: Ia, GOR: A)	No change	1.1. Administration of aspirin is recommended in patients with AIS within 24 to 48 hours after onset. (COR: I, LOE: A)^b

2. Aspirin cannot replace acute interventions including intravenous tPA (LOE: Ia, GOR: A)	2. Aspirin cannot replace acute interventions including intravenous tPA (LOE: Ia, GOR: A)	No change	6. Aspirin is not recommended as a substitute for acute stroke treatment in patients who are otherwise eligible for IV alteplase or mechanical thrombectomy. (COR III: Harm, LOE B-R)^b

3. Aspirin should not be taken within 24 hours of thrombolysis (LOE: Ia, GOR: A).	3. For patients treated with intravenous thrombolysis, it is generally recommended to delay antithrombotic therapy up to 24 hours. However, when the benefit is expected to outweigh the risk, antithrombotic therapy may be initiated within 24 hours after intravenous tPA (LOE: III, GOR: B)	Revised from the previous recommendation	1.2. For those treated with IV alteplase, aspirin administration is generally delayed until 24 hours later but might be considered in the presence of concomitant conditions for which such treatment given in the absence of IV alteplase is known to provide substantial benefit or withholding such treatment is known to cause substantial risk. (COR: I, LOE: A)^b

4. Intravenous injection of the glycoprotein IIb/IIIa receptor antagonists, including abciximab, is not recommended in patients with acute ischemic stroke (LOE: Ib, GOR: A).	4. In general, intravenous glycoprotein IIb/IIIa receptor antagonists is not recommended in patients with acute ischemic stroke (LOE: Ib, GOR: A). However, intravenous and/or intra-arterial use of glycoprotein IIb/IIIa receptor antagonists can be considered in highly selected patients who require rescue therapy during mechanical thrombectomy or emergent angioplasty/stenting, taking into account benefit and risk (LOE: IV, GOR: C)	Revised from the previous recommendation	3. The efficacy of the IV glycoprotein IIb/IIIa inhibitors tirofiban and eptifibatide in the treatment of AIS is not well established. (COR: IIb, LOE: B-R)^b5. The administration of the IV glycoprotein IIb/IIIa inhibitor abciximab as medical treatment for AIS is potentially harmful and should not be performed. (COR: III: Harm, LOE: B-R)^b

	5. In patients presenting with acute minor ischemic stroke (NIHSS score 0–3) or high-risk TIA (ABCD2 score ≥4), dual antiplatelet therapy with aspirin and clopidogrel initiated within 24 hours from the onset and maintained for up to 21–30 days is recommended to further reduce the risk of early recurrent stroke and major ischemic event (LOE: Ia, GOR: A)	New recommendation	2. In patients presenting with minor noncardioembolic ischemic stroke (NIHSS score ≤3) who did not receive IV alteplase, treatment with dual antiplatelet therapy (aspirin and clopidogrel) started within 24 hours after symptom onset and continued for 21 days is effective in reducing recurrent ischemic stroke for a period of up to 90 days from symptom onset. (COR: I, LOE: A)^b

			4. Ticagrelor is not recommended over aspirin for treatment of patients with minor acute stroke. (COR III: No Benefit, LOE B-R)^b

			6. In patients with noncardioembolic ischemic stroke, treatment with triple antiplatelet therapy (aspirin+clopidogrel+dipyridamole) for secondary stroke prevention is harmful and should not be administered. (COR: III: Harm, LOE: B-R)^c

ABCD2 score, a score to predict short-term stroke risk after TIA; AHA, American Heart Association; AIS, acute ischemic stroke; ASA, American Stroke Association; COR, class of recommendation; GOR, grade of recommendation; KCPGS, Korean Clinical Practice Guideline for Stoke; LOE, level of evidence; NIHSS, national institutes of health stroke scale; TIA, transient ischemic attack; tPA, tissue plasminogen activator

a [2.3.4. Antiplatelet agents]

b [e376, 3. General Supportive Care and Emergency Treatment 3.9. Antiplatelet treatment]

c [e393, 6. In-Hospital Institution of Secondary Stroke Prevention 6.6.1. Noncardioembolic ischemic stroke]

Recent changes in KCPGS and corresponding parts in AHA/ASA guidelines are underlined

Korean J Clin Pharm 2024;34:79-99 https://doi.org/10.24304/kjcp.2024.34.2.79