In patients seen within 3 hours of suspected stroke onset (and some seen between 3 and 4.5 hours of symptom onset), consider immediate therapy with iv rtPA to reverse cerebrovascular damage.
Begin adjunctive antiplatelet therapy in patients with acute stroke within the first 48 hours. Delay antiplatelet or anticoagulant therapy if patient has received rtPA until 24 hours after rtPA is given.
Admit patients with stroke to a dedicated stroke unit and manage BP and comorbidities.
Institute antiplatelet therapy for secondary stroke prevention in patients with TIA or stroke.
Strongly consider referring patients with nondisabling stroke or TIA in the past 6 months due to internal carotid stenosis greater than 70% for carotid endarterectomy.
Consider anticoagulation for secondary stroke prevention in patients after TIA or completed stroke due to high-risk sources of cardioembolism, but not due to most other causes of stroke.