secondary prevention for stroke and TIA Flashcards
antiplatelet
low dose aspirin 100mg orally
other alternatives for aspirin for secondary prevention
clopidogrel for patients who cant tolerate aspirin
dipyridamole may be added to aspirin as it is marginally more effective, but only in patients with recurrent cerebral ischaemic events despite aspirin therapy, as adverse events are higher
anticoagulatn therapy to prevent ischaemic stroke in patients wth a fib
DOAC or warfarin
DOAC choices for A fib
apixaban, dbigatran, rivaroxaban
Xa inhbitors
apixaban
rivaroxban
direct thrombin inhibitors
dabigtran
which kind of a fib patients is warfarin recommended for
patients with a fib who have rheumatic mitral stenosis and/or a mechanical heart valve (DOAC is harmful in these patients)
warfarin may also be preferred for concommitant kidney impairment
how should you dose warfarin
dosed to target INR
usually INR 2-3 is target, range may be higher for patients with rheumatic mitral stenosis and/or mechanical heart valve
patients with ischemic stroke or TIA of the carotid circulation
should be screened promptly for a carotid stenosis, which is presumed to be the source of the atheroembolism
if the patient has high gradde ipsilateral carotidd stenosis, refer for urgent carotid endartectomy
the benefit of surgery is greatest within 2 weeks, as this is when risk of recurrent stroke is highest
rarer causes of ischaemic stroke
bacterial endocarditis
cerebral venous thrombosis
carotid or vertebrobasilar arterial dissection
patent foramen ovale
recovery after stroke
mood distrubance and depression are common
some patients are emotionally labile
driving after stroke or TIA
after stroke, privte vehicle driver cannot drive for aat least 4 weeks
commercial vehicle driver cannot drive for at least 3 months
