CV: Management of Stroke

Question 1

Patients suspected of having a TIA should immediately recieve what?

Answer 1

Aspirin, clopidogrel if aspirin intolerant despite PPI

Question 2

What is recommended in the treatment of acute ischaemic stroke if it can be administered within 4.5 hours of symptom onsent?

Answer 2

Alteplase

Question 3

In the management of acute ischaemic stroke, treatment with aspirin should be initiated how long after thombolysis (or as soon as possible within 48 hours of symptom onset if not receiving thrombolysis)?

Answer 3

24 hours

Question 4

Are anticoagulants recommended as an alternative to antiplatelet drugs in acute ischaemic stroke patients in sinus rhythm?

Answer 4

No.

Parenteral anticoagulants may be indicated in patients who are symptomatic of, or at high risk of developing, deep vein thrombosis or pulmonary embolism; warfarin sodium should not be commenced in the acute phase of ischaemic stroke.

Question 5

Following a TIA or an ischaemic stroke (not associated with AF), long-term treatment with what is recommended?

Answer 5

Clopidogrel

Question 6

Following a TIA or an ischaemic stroke (not associated with AF) long-term treatment with what is recommended? (Clopidogrel intolerance)

Answer 6

MR dipyridamole in combination with aspirin.

if both aspirin and clopidogrel are contra-indicated or not tolerated, then modified-release dipyridamole alone is recommended; if both modified-release dipyridamole and clopidogrel are contra-indicated or not tolerated, then aspirin alone is recommended.

Question 7

Patients with stroke associated with AF should be reviewed for long-term treatment with what? (2)

Answer 7

Either warfarin sodium or an alternative anticoagulant.

Question 8

A statin should be initiated how long after stroke symptom onset, irrespective of the patient’s serum-cholesterol concentration?

Answer 8

within 48 hours

Question 9

In the management of intracerebral haemorrohage, aspirin therapy should only be given to patients at high risk of what?

Answer 9

Cardiac ischaemic event.

Question 10

How does alteplase work?

Answer 10

Alteplase is a tissue plasminogen activator.

It catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown.

Question 11

How does dipyridamole work?

Answer 11

Dipyridamole inhibits the phosphodiesterase enzymes that normally break down cAMP.

Increasing cellular cAMP levels and blocking the platelet aggregation response to ADP.