Prevention of Ischemic Stroke

Question 1

What are the risk factors for acquiring a stroke

Answer 1

Atrial Fibrillation, Hypertension, Hyperlipidemia/Obesity, Smoking, Diabetes

Question 2

What are the antiplatelet agents used in Secondary Stroke Prevention

Answer 2

Asprin, Clopidorel, Aggrenox

Question 3

T/F: 325 mg have better chronic stroke prevention than 81 mg

Answer 3

False: There is no verifyable difference in prevention of stroke between an 81 mg dose and a 325 mg dose of aspirin

Question 4

What is the only non oral antiplatelet threapy that can be given for stroke prevention

Answer 4

Asprin Suppositories

Question 5

T/F: There is no significant risk reduction in using either aspirin or clopidogrel for secondary prevention of stroke

Answer 5

True

Question 6

T/F: Mixing asprin and clopodigrel, regardless of order, has a significant benefit of secondar prevention of stroke

Answer 6

False

Question 7

What is in Aggrenox, what is the key counseling point for taking this medication

Answer 7

Extended-release dipyridamole (ERD) 200 mg PLUS Aspirin 25 mg/ Do not crush, chew, or open capsule

Question 8

What is the most prominant side effect of Aggrenox that causes low adherence to the medication, what are teh other side effects, what should be counseled about these side effects

Answer 8

Headches, diarrhea, abdominal/ headaches should subside after one month, take Aggrenox before bed once a day to start then once tolerated move to twice a day

Question 9

For primary prevention of stroke what combination of antiplatelets should be given minor ischemic stroke or high risk TIA, for how long, what constitutes as minor ischemic stroke and high-risk TIA

Answer 9

Clopidogrel PLUS Aspirin started within 24 hours for 21 days then move to monotherapy of just Aspirin/ Minor ischemic stroke = NIHSS score less than or equal to 3, High risk TIA = ABCD2 score greater than or equal to 4

Question 10

What are non modifiable risk factors for stroke

Answer 10

Age greater than 55, family history, race (blacks, hispanics/asians, whites), males, prior stroke or TIA

Question 11

What is the hypertension goal of stroke patients, what antihypertensives can be used, when can they be inititeated

Answer 11

less than 130/80 mmHG/ diuretics and ACE inhibitors, 24- 48 hours after acute stroke

Question 12

What are goals for all stroke patients with diabetes

Answer 12

Fasting glucose less than 126 g/dL, HgbA1c less than 65%, Oral glucose tolerance test less than 200 g/dL

Question 13

T/F: If a patient does not have hyperlipidemia statins have no reason it should be used in secondary prevention of stroke

Answer 13

False: High intensity statins are recommended in patients with previous stroke

Question 14

When a patient stops smoking when does the elevated risk of stroke disappear

Answer 14

After 5 years

Question 15

Stroke/TIA patients diagnosed with atrial fibrillation should automatically be considered for anticoagulation

Answer 15

True

Question 16

When would a person be given an anticoagulation therapy after a stroke, when would they not/ what should be given if they can’t take anticoagulation

Answer 16

Within 14 days after stroke unless high risk for hemorrhage, Aspirin alone