CVD Flashcards
STROKE BNF SUMMARY
A stroke is a serious life-threatening medical condition that happens when the blood supply to part of the brain is cut off.
FAST ACRONYM -
Facial weakness: Can the person smile? Has their mouth or eye drooped?
Arm weakness: Can the person raise both arms?
Speech problems: Can the person speak clearly and understand what you say?
Time to call 999: if you see any of these signs.
Transient ischaemic attack -
Patients suspected of having a transient ischaemic attack should immediately receive aspirin.
Ischaemic stroke: Initial management
1) ALTEPLASE is recommended in the treatment of acute ischaemic stroke if it can be administered within 4.5 hours of symptom onset and if intracranial haemorrhage ruled out
2) ASPIRIN 300mg OD initiated within 24 hours of symptom onset
PPI considered for patients with a history of dyspepsia associated with aspirin
If aspirin CI alternative antiplatelet drug
Anticoagulants not recommended as an alternative to antiplatelet drugs in AIS
Warfarin sodium should not be given in the acute phase of an ischaemic stroke.
Patients with a disabling ischaemic stroke and atrial fibrillation should receive aspirin for 2 weeks before being considered for anticoagulant treatment
Long-term management - to reduce the risk of further cardiovascular events
Following a transient ischaemic attack or an ischaemic stroke :
1st Line - Long-term treatment with CLOPIDOGREL 75mg OD is recommended
If Clopidogrel is contra-indicated or not tolerated:
2nd Line - Modified-release Dipyridamole 200mg BD + Aspirin 75mg OD
If both MR dipyridamole and clopidogrel are contra-indicated or not tolerated:
3rd Line - ASPIRIN 75mg OD alone is recommended
A high-intensity statin (such as atorvastatin 20-80 mg), should be initiated 48 hours after stroke symptom onset in patients not already taking a statin + BP measures and treated to get target BP of <130/80 mmHg.
