DOACs Flashcards
cerebral vascular accident (stroke)
stroke that resolves itself within hrs
no damage on MRI
Treatment same as stroke
assoc. w/ increased risk of stroke in future
ischemic stroke
blockage of some type- causes decreased blood flow and tissue damage;
clot, emboli, plaque
hemorrhagic stroke
bleed in the brain tissue
causes increased pressure, swelling, and tissue damage
hypertension (risk factors for stroke)
lesion in brain and white matter damage
damage occurs before increased BP
due to increased O2 free radicals prod. by perivascular macrophages
increase dietary salt (risk factors for stroke)
decreased cerebral blood flow, endothelial dysfunction, cognitive impairment
microbiome (risk factors for stroke)
altered by lifestyle, diet, meds
alteration of biome + aging = increased stroke risk
atrial fibrillation (risk factors fro stroke)
not completely emptying blood sites and no flow so setup for clotting
increased cholesterol (risk factors for stroke)
plaque formation inhibits blood flow so setup for clotting
diabetes (risk factors for stroke)
better outcomes if 80-130mg/dl
tissue damage due to superoxide formation leads to setup for stroke
ketogenic diet (risk factors for stroke)
can cause tissue damage due to fat metabolism and decreased glucose metabolism= setup for stroke `
stroke prevention
antithrombotics
anticoagulants
DOACs
Statins
manage glucose/salt levels
antihypertensive meds
antithrombotics
aspirin & other plt inhibitors
anticoagulants
warfarin
unfractionated heparin
LMWH
warfarin/ coumadin
inhibits factors 2, 7, 9, 10
hard to manage
easy to reverse
regular testing required
unfractionated heparin
through IV
immediate acting, variable response, must be monitored
LMWH
low molecular weight heparin
immediate acting
must be monitored
DOACs
direct oral anticoagulants
easy to manage
no regular testing/ lab tests for treat. levels
diff. to reverse (out of balance they can bleed)
little dietary effect or drug interaction
cleared by kidney
types of DOACs
Direct factor 2 inhibitors
factor 10a inhibitors
hospital team involved with treatment of stroke
physicians (ED, neurologist, radiologist)
nurses
radiology
pharmacy
lab
PT/OT
social services
treatment of stroke
resolve inflammation
lipoxins and arachidonic acid
anti plt therapy
warfarin (coumadin)
reperfusion therapy
lipoxins and arachidonic acid (treatment of stroke)
decrease neutrophil actions/ cytokines
increase macro action and destruction of inflamm cells
anti plt therapy (treatment of stroke)
recomm. for non disabling cardiovascular disease
plavix+aspirin
reperfusion therapy
clot busters (TPA)
thrombectomy
patient must be good candidate
clot preventers
aspirin
plavix
warfarin (coumadin)
heparin
DOACs
clot busters
alteplase (TPA)
Tenecteplase (TNK)
streptokinase
urokinase
TPA
alteplase
FDA approved
better result if w/in 1 hr
cannot be given after 4.5 hrs
increased risk of bleeding in Asians
bolus & infusion can stop
TNK
genetically modified form of TPA
replaced TPA for Rx of MI
decreased resistance to PAI
cheaper
one bolus- cannot stop
reversal of anticoagulants
aspirin/ plavix (no reversal)
warfarin (vit k, kcentra)
heparin (protamine sulfate)
aspirin/plavix reversal
plts affected for life of plt
no reversal
plt transfusion not recommended
warfarin reversal
vit k
kcentra- plasma concentrate
heparin reversal
protamine sulfate
