What is the recommended treatment for a cerebral infarct that has exceeded the 4.5-hour window for alteplase?

When a cerebral infarction has surpassed the 4.5-hour window for the administration of alteplase, the most recommended treatment is to initiate aspirin therapy. Aspirin is an antiplatelet agent that helps to reduce the risk of further clot formation, which is crucial for patients who have experienced an ischemic stroke.

The use of aspirin is supported by clinical evidence demonstrating its efficacy in the management of acute ischemic stroke beyond the thrombolytic window. While heparin and warfarin are anticoagulants and clopidogrel is another antiplatelet medication, they are not the first-line treatments for acute management of ischemic stroke after the thrombolytic window has passed.

Aspirin not only helps to manage the immediate risks but also provides preventive benefits against future strokes, making it a suitable choice in this scenario. This treatment approach leverages aspirin's established role in secondary prevention in stroke management while addressing the acute aspects of care following the initial event.