American Board of Internal Medicine (ABIM) Certification Practice Exam

Within how many hours should aspirin be administered after an acute ischemic stroke when tPA is not applicable?

1. 12 hours

2. 24 hours

3. 48 hours

4. 72 hours

The correct answer is: 48 hours

Aspirin can be beneficial in the management of acute ischemic stroke when thrombolytic therapy (tPA) is contraindicated or not applicable. The recommendation is to administer aspirin within 48 hours after the onset of stroke symptoms. This timing is critical because aspirin serves to reduce the risk of recurrent stroke or other vascular events. Administering aspirin too soon after symptom onset may increase the risk of bleeding, and waiting longer than 48 hours can delay treatment at a time when the patient might benefit from antiplatelet therapy. Current guidelines support this 48-hour window to ensure the patient receives timely intervention while minimizing the risk of complications. Hence, 48 hours is the optimal timeframe that aligns with clinical guidelines for starting aspirin following an acute ischemic stroke when tPA is not suitable. This practice aims to improve patient outcomes by addressing the underlying issue of thrombus formation and reducing the likelihood of further ischemic events.