new stroke

Question 1

What is the recommended timeframe for administering Alteplase in acute ischaemic stroke?

and what is done after?

Answer 1

Alteplase is recommended within 4.5 hours of symptom onset.

thrombectomy within 6 hours of symptom onset while being on a thrombolytic agent (alteplase)

give aspirin after within 24 hour.

Question 2

When should aspirin treatment be initiated in patients with acute ischaemic stroke?

Answer 2

Aspirin treatment should be initiated as soon as possible within 24 hours of symptom onset.

Question 3

What should patients with aspirin hypersensitivity or intolerance receive instead of aspirin?

Answer 3

They should receive an alternative antiplatelet. like (clopidogrel 75mg once daily)

Question 4

Are anticoagulants recommended as an alternative to antiplatelet drugs in acute ischaemic stroke?

Answer 4

Anticoagulants are not recommended as an alternative to antiplatelet drugs in acute ischaemic stroke in patients who are in sinus rhythm.

Question 5

When might parenteral anticoagulants be indicated in acute ischaemic stroke patients?

Answer 5

They may be indicated in patients who are symptomatic of, or at high risk of developing, deep vein thrombosis or pulmonary embolism.

Question 6

Should Warfarin sodium be given in the acute phase of an ischaemic stroke?

Answer 6

Warfarin sodium should not be given in the acute phase of an ischaemic stroke.

Question 7

What should be given to patients with a disabling ischaemic stroke and atrial fibrillation before considering anticoagulant treatment?

Answer 7

Aspirin should be given for 2 weeks.

Question 8

What should be done for patients receiving anticoagulation for a prosthetic heart valve who experience a disabling ischaemic stroke?

Answer 8

Their anticoagulant treatment should be stopped for 7 days and substituted with aspirin 300 mg once daily.

Question 9

When should treatment of hypertension in the acute phase of ischaemic stroke be instituted?

Answer 9

Treatment of hypertension should only be instituted in the event of a hypertensive emergency (150 and 220 mmHg) or in those patients considered for thrombolysis.

Question 10

What should be considered for patients with a history of dyspepsia associated with aspirin?

Answer 10

A proton pump inhibitor should be considered for those patients.

Question 11

Why is long-term treatment recommended for patients after a transient ischaemic attack or an ischaemic stroke?

Answer 11

Long-term treatment is recommended to reduce the risk of further cardiovascular events.

Question 12

What medication is recommended for long-term treatment after a transient ischaemic attack or an ischaemic stroke not associated with atrial fibrillation?

Answer 12

Long-term treatment with clopidogrel [unlicensed in transient ischaemic attack] is recommended.

Question 13

What medication can be used as an alternative to clopidogrel if it is contra-indicated or not tolerated?

Answer 13

Modified-release dipyridamole (200 mg twice daily) in combination with aspirin (75 mg once daily) can be used.

Question 14

What medication is recommended if both aspirin and clopidogrel are contra-indicated or not tolerated?

Answer 14

Modified-release dipyridamole Modified-release dipyridamole (200 mg twice daily) alone is recommended.

Question 15

What medication is recommended if both modified-release dipyridamole and clopidogrel are contra-indicated or not tolerated?

Answer 15

Aspirin 75 mg aspirin once daily alone is recommended.

Question 16

Who should be reviewed for long-term anticoagulant treatment after an ischaemic stroke or transient ischaemic attack?

Answer 16

Patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation should be reviewed for long-term anticoagulant treatment.

Question 17

When are anticoagulants recommended for long-term prevention of recurrent stroke?

Answer 17

Anticoagulants are not routinely recommended in the long-term prevention of recurrent stroke, except when atrial fibrillation or other indications are present.

Question 18

What medication should be initiated 48 hours after stroke symptom onset in patients not already taking a statin?

Answer 18

A high-intensity statin (20 mg once daily; increased if necessary up to 80 mg once daily, dose to be increased at intervals of at least 4 weeks) should be initiated.

Question 19

What should be done for patients with acute stroke who are already taking a statin?

Answer 19

They can continue statin treatment.

Question 20

Should beta-blockers be used in the management of hypertension following a stroke?

Answer 20

Beta-blockers should not be used in the management of hypertension following a stroke unless they are indicated for a co-existing condition.

Question 21

What lifestyle modifications should all patients be advised to make?
Patients should be advised to make lifestyle modifications that include beneficial changes to diet, exercise, weight, alcohol intake, and smoking cessation.