| Reworded | Patients with AIS are recommended to take aspirin within 24–48 hours after the onset of symptoms. For patients undergoing intravenous thrombolysis, the administration of aspirin is typically delayed until 24 hours after treatment. | I | A |
| Reworded | Monotherapy with either aspirin (50–325 mg/day) or clopidogrel (75 mg/day) can be considered the preferred antiplatelet treatment option for secondary stroke prevention. | I | A |
| Reworded | Ticagrelor monotherapy (as a substitute for aspirin monotherapy) is not recommended for the acute treatment of minor stroke and TIA. | III | B |
| New recommendation | Cilostazol is an alternative treatment to aspirin and clopidogrel for patients with AIS who are at high risk of bleeding. | IIb | B |
| The CASISP study showed that both aspirin and cilostazol could reduce stroke recurrence rates, with no significant difference between the two groups (HR 0.62, 95% CI 0.30 to 1.26, p=0.185).88 However, cilostazol showed a lower incidence of bleeding complications than aspirin (1 vs 7, p=0.034). It makes cilostazol a potentially suitable choice for Chinese patients with IS who have a higher risk of bleeding. The CSPS II study found that in Japanese patients with non-cardioembolic IS, the cilostazol group had a significantly lower annual stroke recurrence rate compared with the aspirin group (2.76% vs 3.71%, relative risk reduction (RRR) 25.7%, p=0.0357).89 Furthermore, the cilostazol group demonstrated a reduced annual incidence of haemorrhagic stroke or haemorrhage necessitating hospitalisation compared with the aspirin group (0.77% vs 1.77%, RRR 54.2%, p=0.0004). However, limited research from non-Asian populations is available to confirm these findings. Therefore, the generalisability of these results to non-Asian populations may require further investigation. |
| Revised | For patients with moderate-to-severe IS, it is not recommended using indobufen for secondary stroke prevention. | III | B |
| The INSURE trial found that compared with aspirin, indobufen did not exhibit a significant reduction in the risk of stroke recurrence (HR 1.23, 95% CI 1.01 to 1.50, p for non-inferiority=0.44) or bleeding (HR 0.63, 95% CI 0.35 to 1.15, p=0.13) at 90 days.90
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| Reworded | Abciximab is not recommended for AIS. | III | B |
| New recommendation | For patients with AIS, receiving intravenous tirofiban before IA MT is not recommended. | III | B |
| The RESCUE BT trial found that compared with placebo, tirofiban did not reduce the risk of disability at 90 days (adjusted OR 1.08, 95% CI 0.86 to 1.36).91
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| New recommendation | Intravenous tirofiban can be beneficial in those patients who meet the RESCUE BT2 trial inclusion criteria. | IIb | B |
| The RESCUE BT2 trial found that administering intravenous tirofiban to a heterogeneous patient group with recent onset or progression of stroke symptoms and non-occluded large and medium-sized cerebral vessels resulted in a higher likelihood of excellent outcomes than low-dose aspirin (adjusted RR 1.26, 95% CI 1.04 to 1.53).92
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