Lecture 11 - Stroke 2 Flashcards
ASA efficacious for secondary stroke prevention?
across the board ASA decreases Vascular events
23% reduction in incidence of stroke for secondary prevention
Dose 81mg-325mg for secondary prevention
Is clopidogrel superior to ASA for secondary stroke prevention
CAPRIE Trial
Not Significantly better in strok, but is efficacious
Was better overall, had slightly more side effects
ER-Dipyridamole/ASA side effects
Headache Flshing Diarrhea Bleeding Nausea Dizziness
~15-20% of ppl
Is ER-DP/ASA superior to ASA for secondary stroke prevention?
ESPS-2, Specific for stroke
showed to be superior to individual components
ESPS-2 Trial results
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
PROFESS study
ER-DP/ASA vs Clopidogrel
Found no difference
MATCH + CHARISM studies
Clopidogrel + ASA
Found no difference in ischemic stroke
Combo is efficacious no better than monotherapy and can cause more bleedings
CHANCE and POINT studies
Clopidogrel + ASA vs ASA for 90 days in minor stroke
Both saw reduction in recurrent stroke
POINT saw increase in bleeding in combo
TARDIS study
Triple therapy
no difference in recurrent stroke
increase in major hemorrhage
WARSS study
Warfarin
no difference in efficacy but increase risk of bleeding
If not pt 1st stroke, they’re on ASA then switch….
Clopidogrel
or
ER-DP/ASA
If not pt 1st stroke, they’re on clopidogrel then switch….
ER-DP/ASA
or
ASA
If not pt 1st stroke, they’re on ER-DP/ASA then switch….
Clopidogrel
or
ASA
PROGRESS Trial
Looked to see if ACEi work in secondary prevention of stroke
ACEi/ Thiazide Diuretic combo reduced RRR: 43%
SPARCL Trial
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
TST Trial
compared LDL goal <70 and LDL goal 90-100
overall <70 group had overall lower incidence of major cardiovascular events
Pre-Thrombolytic BP control
- If pt needs BP control in order to give lytic, monitor q15min until BP is stable to give
- No rule as to how long one takes to control the BP in order to give
- Most clinicians try 3-4 bolus doses before deeming pt not eligible for lytic
- try to avoid continuous infusion for elevated BP prior to lytic use
Alteplase CI
- Ischemic stroke or serious head injury w/in 3 months
- Had undergone major surgery w/in 14 days
- History of ICH or minor stroke symptoms
- Symptoms suggestive of subarachnoid hemorrhage
- GI or urinary tract hemorrhage w/in 21 days
- Seizure at onset of stroke
- Systemic heparin w/in 48 hrs preceding stroke onset
- Current use of oral anticoagulants or an INR > 1.7 or PT >15 sec
- Platelet count <100,000 mm3
- Glucose <50mg/dl or >400mg/dL
- Active internal bleeding
- Arterial puncture at a noncompressible site w/in 7 days
- Intracranial neoplasm, AV malformation, or aneurysm
Clopidogrel MOA
Block ADP receptors
Aspirin MOA
Inhibits cyclooxygenase and thrombaxane A2
Dipyridamole MOA
Inhibit platelet phosphodiesterase
Increase plasma adenosine
