Lecture 11 - Stroke 2

Question 1

ASA efficacious for secondary stroke prevention?

Answer 1

across the board ASA decreases Vascular events

23% reduction in incidence of stroke for secondary prevention

Dose 81mg-325mg for secondary prevention

Question 2

Is clopidogrel superior to ASA for secondary stroke prevention

Answer 2

CAPRIE Trial

Not Significantly better in strok, but is efficacious

Was better overall, had slightly more side effects

Question 3

ER-Dipyridamole/ASA side effects

Answer 3

Headache
Flshing
Diarrhea
Bleeding
Nausea
Dizziness

~15-20% of ppl

Question 4

Is ER-DP/ASA superior to ASA for secondary stroke prevention?

Answer 4

ESPS-2, Specific for stroke

showed to be superior to individual components

Question 5

ESPS-2 Trial results

Answer 5

No difference in mortality

No different in bleeding between ASA and ER-DP/ASA

Sig inc in headache and GI side effects w/ ER-DP/ASA

Question 6

PROFESS study

Answer 6

ER-DP/ASA vs Clopidogrel

Found no difference

Question 7

MATCH + CHARISM studies

Answer 7

Clopidogrel + ASA

Found no difference in ischemic stroke

Combo is efficacious no better than monotherapy and can cause more bleedings

Question 8

CHANCE and POINT studies

Answer 8

Clopidogrel + ASA vs ASA for 90 days in minor stroke

Both saw reduction in recurrent stroke

POINT saw increase in bleeding in combo

Question 9

TARDIS study

Answer 9

Triple therapy

no difference in recurrent stroke

increase in major hemorrhage

Question 10

WARSS study

Answer 10

Warfarin

no difference in efficacy but increase risk of bleeding

Question 11

If not pt 1st stroke, they’re on ASA then switch….

Answer 11

Clopidogrel

or

ER-DP/ASA

Question 12

If not pt 1st stroke, they’re on clopidogrel then switch….

Answer 12

ER-DP/ASA

or

ASA

Question 13

If not pt 1st stroke, they’re on ER-DP/ASA then switch….

Answer 13

Clopidogrel

or

ASA

Question 14

PROGRESS Trial

Answer 14

Looked to see if ACEi work in secondary prevention of stroke

ACEi/ Thiazide Diuretic combo reduced RRR: 43%

Question 15

SPARCL Trial

Answer 15

Looked to see if Statin help with secondary stroke prevention

overall efficacious in secondary prevention of stroke w/o CHD

no Dif in mortality, or adverse events

results support concept of stroke or TIA as a CHD risk equivalent

Question 16

TST Trial

Answer 16

compared LDL goal <70 and LDL goal 90-100

overall <70 group had overall lower incidence of major cardiovascular events

Question 17

Pre-Thrombolytic BP control

Answer 17

1. If pt needs BP control in order to give lytic, monitor q15min until BP is stable to give
2. No rule as to how long one takes to control the BP in order to give
3. Most clinicians try 3-4 bolus doses before deeming pt not eligible for lytic
4. try to avoid continuous infusion for elevated BP prior to lytic use

Question 18

Alteplase CI

Answer 18

1. Ischemic stroke or serious head injury w/in 3 months
2. Had undergone major surgery w/in 14 days
3. History of ICH or minor stroke symptoms
4. Symptoms suggestive of subarachnoid hemorrhage
5. GI or urinary tract hemorrhage w/in 21 days
6. Seizure at onset of stroke
7. Systemic heparin w/in 48 hrs preceding stroke onset
8. Current use of oral anticoagulants or an INR > 1.7 or PT >15 sec
9. Platelet count <100,000 mm3
10. Glucose <50mg/dl or >400mg/dL
11. Active internal bleeding
12. Arterial puncture at a noncompressible site w/in 7 days
13. Intracranial neoplasm, AV malformation, or aneurysm

Question 19

Clopidogrel MOA

Answer 19

Block ADP receptors

Question 20

Aspirin MOA

Answer 20

Inhibits cyclooxygenase and thrombaxane A2

Question 21

Dipyridamole MOA

Answer 21

Inhibit platelet phosphodiesterase

Increase plasma adenosine