STROKE Flashcards

1
Q

Types of strokes

A
  1. Transient ischaemic attack
    (TIA)
    - often described as a “mini-stroke”
  2. Ischaemic stroke
  3. Intracerebral haemorrhage
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2
Q

Initial management of transient ischaemic stroke (TIA)?

A
  1. Immediately give aspirin
    300mg
    - If Cl then alternative antiplatelet e.g. clopidogrel
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3
Q

Long term management of TIA

A
  1. 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)
  2. Statin after 48 hours after stroke
  3. BP meds to get to a target of 130/80mmHg
  4. Lifestyle modifications
    - Diet, smoking cessation etc.
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4
Q

If clopidogrel is contraindicated in the long term
management of TIA or ischaemic stroke, what else can the patient take?

A
  1. MR Dipyrimadole + Aspirin (in combination)
    - If contraindicated to Clopidogrel ONLY
  2. MR Dipyrimadole on its own
    - if contraindicated to Aspirin and Clopidogrel
  3. Aspirin on its own
    - If contraindicated to Clopidogrel and MR dipyrimadole
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5
Q

When would anticoagulants be recommended for long-term management of TIA or
Ischaemic stroke?

A

ONLY in patients with stroke associated with AF (or other indications)

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6
Q

Initial management of Ischaemic stroke

A
  1. Alteplase within 4.5 hours
  2. Aspirin 300mg ASAP or within 24 hours
    - If Cl to aspirin, give Clopidogrel
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7
Q

Are anticoagulants recommended in the initial management of an ischaemic stroke?

A

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

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8
Q

When would Anticoagulants be considered for
someone who had an ischaemic stroke associated with AF?

A
  • 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
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9
Q

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?

A
  • These patients should have their anticoagulation
    therapy stopped for 7 days and substituted with aspirin
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10
Q

Long-term management of Ischaemic stroke
Stroke not associated with AF

A
  1. Long term treatment with Clopidogrel
    - Or Dipyrimadole + Aspirin
    - Or just Dipyrimadole on its own
    - Or Aspirin on its own
  2. Statin after 48 hours after stroke
  3. Blood pressure
    medications to get to a target of 130/80mmHg
  4. Lifestyle modifications
    - e.g. Diet, smoking cessation etc
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11
Q

Long-term management of Ischaemic stroke
Stroke Associated with AF:

A
  1. Anticoagulants (e.g. Warfarin)
  2. Statin after 48 hours after stroke
  3. Blood pressure
    medications to get to a target of 130/80mmHg
  4. Lifestyle modifications
    - e.g. Diet, smoking cessation etc
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12
Q

Does the serum-cholesterol concentration matter prior to commencing statin in the long term management of TIA or
Ischaemic stroke?

A
  • NO
  • You must offer statin irrespective of serum-cholesterol concentration
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13
Q

Initial management of
Intracerebral haemorrhage

A
  1. Surgical intervention to remove the haematoma and relieve intracranial pressure
  2. BP management
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14
Q

Long term management of
Intracerebral haemorrhage

A
  1. 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
  2. Blood pressure should be measured and treatment initiated where appropriate
  3. AVOID STATINS
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