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SSP > Chapter 4. Guidelines for Antiplatelet Therapy in Non-Cardioembolic Stroke or TIA > Flashcards

Chapter 4. Guidelines for Antiplatelet Therapy in Non-Cardioembolic Stroke or TIA Flashcards

1
Q

The combination of ASA and clopidogrel in the first 24 hours and continued until how many months

A

3 months

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2
Q

What is the risk of ASA and clopidogrel if continued for 2-3 years

A

Bleeding

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3
Q

What is the result of Antiplatelet Trialist Collaboration (ATC)

A
  1. 23% reduction in composite outcome

2. Highest risk reduction in low to medium dose aspirin

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4
Q

What is the dose of ASA used in ATC

A

50-150/day

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5
Q

What is the result of Canadian American Ticlopidine Study

A

Ticlopidine decreased the risk of composite outcome of MI and stroke and vascular death by 30%

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6
Q

This study compared Ticlopidine vs ASA in acute ischemic stroke

A

Ticlopidine-Aspirin in Stroke Recovery (TASS trial)

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7
Q

What is the result of Ticlopidine-Aspirin in Stroke Recovery (TASS trial)

A
  1. Ticlopidine reduces risk of stroke and death at 3 years by 12% relative to ASA
  2. Neutropenia is common in Ticlopidine
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8
Q

Give 2 studies of Ticlopidine in acute ischemic stroke

A

CATS

TASS

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9
Q

This study compares Clopidogrel to Aspirin in acute ischemic stroke

A

Clopidogrel vs ASA at Risk of Ischemic Events (CAPRIE)

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10
Q

What is the result of CAPRIE trial

A
  1. Clopidogrel decreased the combined endpoint of MI and Stroke at 8.7%
  2. Benefit was greatest on patients with PAD
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11
Q

This study compares efficacy of combination of clopidogrel and ASA vs Clopidogrel in TIA and stroke

A

Management of Atherothrombisis with Clopidogrel in High Risk Patients with TIA or Stroke

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12
Q

What is the result of Management of Atherothrombisis with Clopidogrel in High Risk Patients with TIA or Stroke

A
  1. No significant difference between combined endpoint

2. Increased bleeding in combination

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13
Q

This study compared the efficacy of combination of clopidogrel + ASA vs ASA as monotherapy

A

Clopidogrel for high atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA)

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14
Q

What is the result of CHARISMA trial

A
  1. Combination therapy was not significantly more effective than ASA
  2. Benefits of combination treated with symptomatic disease
  3. High risk bleeding in combination therapy
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15
Q

This study compared the efficacy of combination therapy of Clopidogrel + ASA vs ASA monotherapy in lacunar infarction

A

Secondary Prevention of Small Subcortical Stroke. (SPS3)

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16
Q

What is the Result of SPS3 trial

A
  1. No significant difference between 2 groups

2. Increase bleeding in combination

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17
Q

This study Cilostazol in patient with cerebral infarction within 6 months

A

Cilostazol Stroke Prevention Study (CSPS)

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18
Q

What is the result of CSPS

A

Cilostazol reduced recurrent stroke by 41.7%

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19
Q

What are the trial that compared Clopidogrel VS ASA

A

CAPRIE
CHARISMA
SPS3
Management of Atherothrombisis with Clopidogrel in High Risk Patients with TIA or Stroke

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20
Q

This study compared Cilostazol + ASA vs ASA monotherapy in patient with symptomatic ICAS

A

Trial on Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS-1)

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21
Q

What is the Result of TOSS-1

A

The progression of symptomatic ICAD was lower in combination group

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22
Q

This study compared combination of Cilostazol vs ASA monotherapy in acute ischemic stroke

A

Cilostazol Stroke Prevention Study 2 (CSPS-2)

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23
Q

What is the result of Cilostazol Stroke Prevention Study 2 (CSPS-2)

A
  1. Annual stroke recurrence : 2.76 (cilostazol) vs 3.71% (ASA)
  2. Less hemorrhagic event and diarrhea in Cilostazol
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24
Q

This trial assessed the efficacy of combination therapy of cilostazol + ASA vs Clopidogrel + ASA in ICAD

A

Trial on Cilostazol in Symptomatic Intracranial Stenosis (TOSS-2)

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25
Q

What is the result of TOSS-2 Trial

A
  1. No significant difference of progression of ICAS between 2 groups
  2. Favorable lipoprotein produce trends toward less hemorrhagic in cilostazol group
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26
Q

This trial study the efficacy of Dypiridamole vs ASA

A

European Stroke Prevention Study I (ESPS-1)

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27
Q

What is the result of European Stroke Prevention Study I (ESPS-1)

A

Active treatment reduced rate of stroke and death by 33%

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28
Q

This trial study the efficacy of combination ASA + Dypiridamole vs ASA vs placebo

A

European Stroke Prevention Study 2 (ESPS-2)

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29
Q

What is the result of ESPS-2

A
  1. Stroke Reduction in ASA (18%), ASA+Dypridamole (37.8)

2. No risk of bleeding

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30
Q

What is the result of European Australian Stroke Prevention in Reversible Ischemia Trial (ESPRIT)

A
  1. Composite outcome were reduce by 20% with ASA+Dypridamole

2. No increased in bleeding with combination

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31
Q

This study compared the efficacy of 3 antiplatelet: ASA + Dypiridamole vs Clopidogrel

A

Prevention Regimen for Effectively Avoidinmg Second Stroke (PROFESS)

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32
Q

What is the result of PROFESS

A
  1. Recurrent stroke at 2.5 years: ASA+Dypiridamole 9% vs Clopidogrel 8.8%
  2. No major bleeding on combination vs clopidogrel
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33
Q

This trial compared efficacy of Triflusal vs ASA

A

Triflusal-Aspirin Cerebral Infarction Prevention (TACIP)

34
Q

What is the result of TACIP trial

A
  1. Similar efficacy between 2 groups in endpoint combination: Triflusal 13.5% vs ASA 12.4%
  2. Triflusal is associated with less bleeding risk
35
Q

This trial compared the efficacy of Triflusal vs ASA in the a 28 months follow-up

A

Triflusal vs ASA in the Prevention of Infarction: A Randomized Stroke Study (TAPIRSS)

36
Q

Result of TAPIRSS

A
  1. Non-significant difference in combined endpoint of stroke MI and major bleeding
  2. Triflusal was associated with less bleeding
37
Q

This study compared efficacy of ASA vs Warfarin in non cardio embolic stroke

A

Warfarin-Aspirin Recurrent Stroke Study (WARSS)

38
Q

Result of Warfarin-Aspirin Recurrent Stroke Study (WARSS)

A
  1. No difference between 2 groups in recurrent ischemic stroke or death at 2 years
39
Q

This study compared ASA and Warfarin in symptomatic intracranial disease

A

Warfarin vs Asprin in Symptomatic Intracranial Disease (WASID)

40
Q

What is the conclusion of WASID

A

No significant difference in 2 years between 2 groups

VKA 17.2% vs ASA 19.7%

41
Q

What dose of ASA will produce overt GI bleeding

A

> 325mg/day

42
Q

What is the rate of stroke in patient with AF

A

4.5%

43
Q

Atrial Fibirllation is responsible for how many percent of stroke

A

15-20%

44
Q

What is the prevalence of AF

A

0.2%

45
Q

What is the annual bleeding risk of Warfarin

A

1-12%

46
Q

This is derived from risk factors identified in data-set of non-VKA treated patients

A

CHADS2

47
Q

This identifies the ā€œtruly low riskā€ patient with AF

A

CHA2DS2VASc

48
Q

Annual stroke risk of CHA2DS2VASc 8

A

12.5%

49
Q

Annual stroke risk of CHA2DS2VASc 4

A

4.0%

50
Q

Annual stroke risk of CHA2DS2VASc 9

A

15.2%

51
Q

Annual stroke risk of CHA2DS2VASc 7

A

9.6%

52
Q

Annual stroke risk of CHA2DS2VASc 2

A

2.2%

53
Q

Annual stroke risk of CHA2DS2VASc 3

A

3.2%

54
Q

Annual stroke risk of CHA2DS2VASc 5

A

6.7%

55
Q

Annual stroke risk of CHA2DS2VASc 1

A

1.3%

56
Q

What CHA2DS2VASc is considered as high-risk

A

Score of 2 and above

57
Q

What CHA2DS2VASc is indication for anticoagulation

A

Score of 1

58
Q

This scoring measures the bleeding risk of patient on anticoagulation

A

HAS-BLEED

59
Q

What is H in HAS-BLED

A

Hypertension

SBP >160

60
Q

When will you score 2 on ā€œDā€ in HAS BLEED

A

2 if with alcohol abuse

61
Q

Major bleeding is defined as

A
  1. ICH
  2. Bleeding requiring hospitalization
  3. Hgb decreased of > 2g/L
  4. Transfusion of > 2 units
62
Q

In NVAF, ASA can reduce the incidence of stroke vs placebo by

A

24%

63
Q

Warfarin reduced incidence of stroke in patient with NVAF

A

64%

64
Q

Combination of ASA and Warfarin in NVAF reduce the stroke by

A

38%

65
Q

What is the effective combination therapy than anticoagulation monotherapy a

A

Triflusal + acenocoumarol

66
Q

Study on DABIGATRAN

A

Re-LAY

67
Q

Results on RE-Lay on Dabigatran 110

A
  1. non-inferior in reduction in stroke

2. Lesser bleeding

68
Q

Study on Rivaroxaban

A

ROCKET-AF

69
Q

Result of Rocket-AD

A
  1. Non-infeeriro in risk reduction
  2. Similar bleeding risk
  3. Substudy: Similar ischemic stroke by lesser hemorrhagic stroke
70
Q

Study on Apixaban

A

ARISTOTLE

71
Q

Results of Aristotle

A
  1. Superior than VKA in risk reduction for stroke and systemic emboli
  2. Lesser major bleeding
72
Q

Among NOACs, what is the superior in reduction of ischemic stroke

A

Dabigatran 150

73
Q

Among NOACs, what is the superior in reduction of all-cause mortality

A

Apixaban

74
Q

Among NOACs, what is the superior in reduction of Vascular Mortality

A

Dabigatran

75
Q

Among NOACs, what is the superior in reduction of lesser bleeding tendency

A

Dabigatran 110

Apixaban

76
Q

What is not indicated for NOAC

A

Severe renal impairment with CrCl <30

77
Q

Absolute contraindication for VKA

A
  1. Large Esophageal varices
  2. Thrombocytopenia <50
  3. Surgery within 72 hours
  4. Hypersensitivity
  5. Clinically significant bleed
  6. Decompensated liver disease
  7. Pregnancy
78
Q

What is the rule in giving anticoagulation

A

1-3-6-12 rule

1: TIA
3: small non-disabling stroke
6: moderate stroke
12: large infarct involving large arterial

79
Q

Dabigatran level is increased with the following medication

A
  1. Quinidine
  2. Amiodarone
  3. Dronedarone
  4. Atorvastatin
  5. Verapamil
  6. Azoles (antifungal)
    QADAVA
80
Q

What is the antidote for Dabigatran

A

Idarucizimab

SSP (7 decks)

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