STROKE Flashcards
Types of strokes
- Transient ischaemic attack
(TIA)
- often described as a “mini-stroke” - Ischaemic stroke
- Intracerebral haemorrhage
Initial management of transient ischaemic stroke (TIA)?
- Immediately give aspirin
300mg
- If Cl then alternative antiplatelet e.g. clopidogrel
Long term management of TIA
- For strokes NOT associated with AF:
Long term treatment with Clopidogrel (unlicensed in TIA)
- Or Dipyrimadole + Aspirin
- Or just Dipyrimadole on its own
- Or Aspirin on its own
Stroke Associated with AF:
- Anticoagulants (e.g. Warfarin) - Statin after 48 hours after stroke
- BP meds to get to a target of 130/80mmHg
- Lifestyle modifications
- Diet, smoking cessation etc.
If clopidogrel is contraindicated in the long term
management of TIA or ischaemic stroke, what else can the patient take?
- MR Dipyrimadole + Aspirin (in combination)
- If contraindicated to Clopidogrel ONLY - MR Dipyrimadole on its own
- if contraindicated to Aspirin and Clopidogrel - Aspirin on its own
- If contraindicated to Clopidogrel and MR dipyrimadole
When would anticoagulants be recommended for long-term management of TIA or
Ischaemic stroke?
ONLY in patients with stroke associated with AF (or other indications)
Initial management of Ischaemic stroke
- Alteplase within 4.5 hours
- Aspirin 300mg ASAP or within 24 hours
- If Cl to aspirin, give Clopidogrel
Are anticoagulants recommended in the initial management of an ischaemic stroke?
Not recommended
- However, parenteral anticoagulants may be recommended in patients who are symptomatic of or at high risk of VTE (DVT or PE)
- Warfarin SHOULD NOT be commenced in the acute phase of ischaemic stroke
When would Anticoagulants be considered for
someone who had an ischaemic stroke associated with AF?
- They’d usually be considered after a stroke (long term management not initial)
- Therefore these patients should receive aspirin (normally for 2 weeks) before being considered for anticoagulation therapy
If a patient is already receiving
anticoagulation for a prosthetic heart valve and they experience an ischaemic stroke, what do you do to their medication if they are at high risk of haemorrhage transformation?
- These patients should have their anticoagulation
therapy stopped for 7 days and substituted with aspirin
Long-term management of Ischaemic stroke
Stroke not associated with AF
- Long term treatment with Clopidogrel
- Or Dipyrimadole + Aspirin
- Or just Dipyrimadole on its own
- Or Aspirin on its own - Statin after 48 hours after stroke
- Blood pressure
medications to get to a target of 130/80mmHg - Lifestyle modifications
- e.g. Diet, smoking cessation etc
Long-term management of Ischaemic stroke
Stroke Associated with AF:
- Anticoagulants (e.g. Warfarin)
- Statin after 48 hours after stroke
- Blood pressure
medications to get to a target of 130/80mmHg - Lifestyle modifications
- e.g. Diet, smoking cessation etc
Does the serum-cholesterol concentration matter prior to commencing statin in the long term management of TIA or
Ischaemic stroke?
- NO
- You must offer statin irrespective of serum-cholesterol concentration
Initial management of
Intracerebral haemorrhage
- Surgical intervention to remove the haematoma and relieve intracranial pressure
- BP management
Long term management of
Intracerebral haemorrhage
- Aspirin and Anticoagulants are NOT recommended
- Specialist advice should be sought for patients with atrial fibrillation and those at a high risk of ischaemic stroke or cardiac ischaemic events - Blood pressure should be measured and treatment initiated where appropriate
- AVOID STATINS