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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
What is the result of TOSS-2 Trial
1. No significant difference of progression of ICAS between 2 groups 2. Favorable lipoprotein produce trends toward less hemorrhagic in cilostazol group
26
This trial study the efficacy of Dypiridamole vs ASA
European Stroke Prevention Study I (ESPS-1)
27
What is the result of European Stroke Prevention Study I (ESPS-1)
Active treatment reduced rate of stroke and death by 33%
28
This trial study the efficacy of combination ASA + Dypiridamole vs ASA vs placebo
European Stroke Prevention Study 2 (ESPS-2)
29
What is the result of ESPS-2
1. Stroke Reduction in ASA (18%), ASA+Dypridamole (37.8) | 2. No risk of bleeding
30
What is the result of European Australian Stroke Prevention in Reversible Ischemia Trial (ESPRIT)
1. Composite outcome were reduce by 20% with ASA+Dypridamole | 2. No increased in bleeding with combination
31
This study compared the efficacy of 3 antiplatelet: ASA + Dypiridamole vs Clopidogrel
Prevention Regimen for Effectively Avoidinmg Second Stroke (PROFESS)
32
What is the result of PROFESS
1. Recurrent stroke at 2.5 years: ASA+Dypiridamole 9% vs Clopidogrel 8.8% 2. No major bleeding on combination vs clopidogrel
33
This trial compared efficacy of Triflusal vs ASA
Triflusal-Aspirin Cerebral Infarction Prevention (TACIP)
34
What is the result of TACIP trial
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
This trial compared the efficacy of Triflusal vs ASA in the a 28 months follow-up
Triflusal vs ASA in the Prevention of Infarction: A Randomized Stroke Study (TAPIRSS)
36
Result of TAPIRSS
1. Non-significant difference in combined endpoint of stroke MI and major bleeding 2. Triflusal was associated with less bleeding
37
This study compared efficacy of ASA vs Warfarin in non cardio embolic stroke
Warfarin-Aspirin Recurrent Stroke Study (WARSS)
38
Result of Warfarin-Aspirin Recurrent Stroke Study (WARSS)
1. No difference between 2 groups in recurrent ischemic stroke or death at 2 years
39
This study compared ASA and Warfarin in symptomatic intracranial disease
Warfarin vs Asprin in Symptomatic Intracranial Disease (WASID)
40
What is the conclusion of WASID
No significant difference in 2 years between 2 groups | VKA 17.2% vs ASA 19.7%
41
What dose of ASA will produce overt GI bleeding
> 325mg/day
42
What is the rate of stroke in patient with AF
4.5%
43
Atrial Fibirllation is responsible for how many percent of stroke
15-20%
44
What is the prevalence of AF
0.2%
45
What is the annual bleeding risk of Warfarin
1-12%
46
This is derived from risk factors identified in data-set of non-VKA treated patients
CHADS2
47
This identifies the "truly low risk" patient with AF
CHA2DS2VASc
48
Annual stroke risk of CHA2DS2VASc 8
12.5%
49
Annual stroke risk of CHA2DS2VASc 4
4.0%
50
Annual stroke risk of CHA2DS2VASc 9
15.2%
51
Annual stroke risk of CHA2DS2VASc 7
9.6%
52
Annual stroke risk of CHA2DS2VASc 2
2.2%
53
Annual stroke risk of CHA2DS2VASc 3
3.2%
54
Annual stroke risk of CHA2DS2VASc 5
6.7%
55
Annual stroke risk of CHA2DS2VASc 1
1.3%
56
What CHA2DS2VASc is considered as high-risk
Score of 2 and above
57
What CHA2DS2VASc is indication for anticoagulation
Score of 1
58
This scoring measures the bleeding risk of patient on anticoagulation
HAS-BLEED
59
What is H in HAS-BLED
Hypertension SBP >160
60
When will you score 2 on "D" in HAS BLEED
2 if with alcohol abuse
61
Major bleeding is defined as
1. ICH 2. Bleeding requiring hospitalization 3. Hgb decreased of > 2g/L 4. Transfusion of > 2 units
62
In NVAF, ASA can reduce the incidence of stroke vs placebo by
24%
63
Warfarin reduced incidence of stroke in patient with NVAF
64%
64
Combination of ASA and Warfarin in NVAF reduce the stroke by
38%
65
What is the effective combination therapy than anticoagulation monotherapy a
Triflusal + acenocoumarol
66
Study on DABIGATRAN
Re-LAY
67
Results on RE-Lay on Dabigatran 110
1. non-inferior in reduction in stroke | 2. Lesser bleeding
68
Study on Rivaroxaban
ROCKET-AF
69
Result of Rocket-AD
1. Non-infeeriro in risk reduction 2. Similar bleeding risk 3. Substudy: Similar ischemic stroke by lesser hemorrhagic stroke
70
Study on Apixaban
ARISTOTLE
71
Results of Aristotle
1. Superior than VKA in risk reduction for stroke and systemic emboli 2. Lesser major bleeding
72
Among NOACs, what is the superior in reduction of ischemic stroke
Dabigatran 150
73
Among NOACs, what is the superior in reduction of all-cause mortality
Apixaban
74
Among NOACs, what is the superior in reduction of Vascular Mortality
Dabigatran
75
Among NOACs, what is the superior in reduction of lesser bleeding tendency
Dabigatran 110 | Apixaban
76
What is not indicated for NOAC
Severe renal impairment with CrCl <30
77
Absolute contraindication for VKA
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
What is the rule in giving anticoagulation
1-3-6-12 rule 1: TIA 3: small non-disabling stroke 6: moderate stroke 12: large infarct involving large arterial
79
Dabigatran level is increased with the following medication
1. Quinidine 2. Amiodarone 3. Dronedarone 4. Atorvastatin 5. Verapamil 6. Azoles (antifungal) QADAVA
80
What is the antidote for Dabigatran
Idarucizimab

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