American Board of Internal Medicine (ABIM) Certification Practice Exam

What initial treatment is recommended for a patient with suspected ischemic stroke who meets exclusion criteria for thrombolysis?

1. Low-dose aspirin

2. High-dose aspirin

3. Clopidogrel

4. Intravenous thrombolytics

The correct answer is: High-dose aspirin

In cases of suspected ischemic stroke where a patient meets exclusion criteria for thrombolysis, the recommended initial treatment is high-dose aspirin. This approach is rooted in the need for early antiplatelet therapy to reduce the risk of further thrombotic events and minimize the potential for disability. High-dose aspirin is typically initiated within 24 to 48 hours after an ischemic stroke event, as studies have shown it can be beneficial in preventing recurrent strokes and other cardiovascular events. Aspirin works by inhibiting platelet aggregation, which can help prevent the development of new clots after the initial ischemic event. While low-dose aspirin may also provide some benefits, high-dose aspirin is more effective in this acute setting due to its stronger anti-platelet effect. Clopidogrel is another antiplatelet medication, but it is generally not used as first-line therapy in the acute management of ischemic stroke. Clopidogrel may be used later in treatment or as part of a combination therapy strategy, but it is not indicated immediately after the stroke when the priority is to initiate treatment swiftly. Intravenous thrombolytics are not appropriate in this scenario since the patient has already met criteria for exclusion, which could be based on factors such as