Hemorrhagic Stroke

Question 1

Reversal agents

Answer 1

Warfarin–> Vitamin K, PCC
Heparin–>protamine sulfate
DOAC–>Andexanet
Dabigatran–>Idarucizumab

Question 2

Blood pressure

Answer 2

Treat if SBP > 180
Within 24 hours: < 180/110
After 24 hours: < 160/90
After 48 hours: < 130/80

Subarachnoid hemorrhagic stroke: to prevent cerebral vasospasm within 4-21 days
Nimodipine 60 mg q4h x 21 days

Question 3

Seizure

Answer 3

Primary prophylaxis=n/a
Secondary prophylaxis=anticonvulsants

Question 4

Aspirin

Answer 4

1st line for Secondary prevention
Atherosclerotic ischemic–> indefinitely

First 2-4 weeks: high dose
After 4 weeks: low dose

SE: GI bleeding, nausea

Question 5

Dipyridamole/aspirin

Answer 5

1st line for secondary prevention

After 2-4 weeks of high dose aspirin alone

Dose: dipryridamole 200 mg/aspirin 25 mg PO BID

Side effects: bleeding, HEADACHE

Question 6

Do we use aspirin in cardioembolic for secondary prevention?

Answer 6

NO

Question 7

Do we use aspirin in hemorrhagic?

Answer 7

NO

Question 8

Do we use anticoagulants in atherosclerotic stroke for secondary prevention?

Answer 8

NO

Question 9

Do we use anticoagulants in cardioembolic for secondary prevention?

Answer 9

YES

When? 2-14 days after high dose aspirin
DOAC or warfarin

Warfarin in mechanical valve or LV thrombus

Question 10

Anticoagulants in hemorrhagic for secondary prevention?

Answer 10

NO

Question 11

Blood pressure for secondary prevention

Answer 11

Goal: < 130/80

Black: thiazides, CCB
CKD: ACE/ARB
CAD: ACE/ARB, BB
DM: ACE/ARB
HF: BB, CE/ARB/ARNI
A-fib: BB, non-DHP CCB

Question 12

Lipids

Answer 12

Atherosclerotic ischemic–> high intensity statin

Atorvastatin: 40-80 mg
Rosuvastatin: 20-40 mg

LDL< 70

Question 13

Depression

Answer 13

SSRI