Should aspirin and nitroglycerin be given for suspected stroke?

• A. Yes to both
• B. Nitro only
• C. Aspirin only
• D. No to both

Answer: (D)

When a stroke is suspected, you withhold both aspirin and nitroglycerin in the field. The reason is you can’t distinguish ischemic from hemorrhagic stroke before imaging. Aspirin can help in ischemic stroke by preventing further clotting, but if the stroke is hemorrhagic, it can worsen bleeding. Nitroglycerin lowers blood pressure and can reduce cerebral perfusion, potentially making brain injury worse. Because the patient could have a hemorrhagic stroke or other conditions, the safest approach is rapid transport to a stroke center and evaluation with imaging, rather than giving these medications in the field. If aspirin were to be given, it’s typically only after imaging confirms an ischemic stroke and a clinician approves it, not as a routine prehospital step.