Antithrombotic Treatment

Question 1

What is ABCD2 score

Answer 1

Risk of stroke after a TIA
high risk is >= 4
Components are:
age (>60)
high blood pressure
diabetes
duration of symptoms
clinical features (unilateral weakness, speach)

Question 2

What is the treatment for TIA with low risk ABCD2 vs high risk abcd2

Answer 2

if low risk, use aspirin alone. If high risk use dual antiplatelet therapy with aspirin and clopidogrel

Question 3

When should you consider anticoagulation as treatment after TIA

Answer 3

When patient was already on anticoagulants or has a condition that warrants anitcoagulation. In instances where the TIA was likely caused by atheroscleroris, may consider adding a single antiplatelet therapy (avoid anticoag +DAPT)

Question 4

What does antiplatelet and anticoagulant treatment look like for patients with AIS

Answer 4

• start antiplatelet treatment as soon as possible (must wait 24 hrs after tpa)
• for mild ais, start anticoag 6-8 days after
• severe ais 12-14 days after

Question 5

How do you adjust antithrombotic treatment if there is a hemorrhagic transformation

Answer 5

if severe- halt antithrombotic treatment for one to two weeks
if asymptomatic- continue aspirin, but not DAPT

Question 6

When is parenteral anticoagulation recommended

Answer 6

this is controversial

cardiac source for tia or ais can give heparin

Question 7

Discuss longterm antithrombotic treatment after TIA and AIS

Answer 7

Minor TIA and Major AIS - aspirin

Major TIA and Minor AIS (or cause is large artery atheroscleroris)- DAPT