Stroke

Question 1

suspected of TIA (aka minor stroke), give

Answer 1

immediately receive aspirin, unless contraindicated

Question 2

within 24h of TIA + low risk of bleed given

Answer 2

DAPT
clopidogrel + aspirin
~ followed by clopidogrel monotherapy
~ add PPI if hx of dyspepsia or reducing GI hemorrhage risk

Question 3

Ischaemic stroke

Answer 3

~ Alteplase / tenecteplase IF within 4.5 hours of symptom onset + intracranial haemorrhage excluded
~ start anti-platelet 24h after thrombolysis

Question 4

disabling acute ischaemic stroke

Answer 4

~ aspirin (unless contraindicated) ASAO within 24 hours + continued for 2 weeks after stroke

Question 5

Anticoagulants and Ischaemic stroke

Answer 5

not recommended as alternative in patients in sinus rhythm. But, may be indicated in ischaemic stroke + symptomatic DVT or PE
~ If immobility after acute stroke not routinely given LMWH or graduated compression stockings for prevention of DVT.
~ Warfarin NOT given in acute phase of ischaemic stroke.

Question 6

already on anticoagulant for prosthetic heart valve and had ischemic stroke + at risk of bleed …

Answer 6

STOP ANTICOAGULANT TX for 7 days !! and substitute aspirin.

Question 7

long-term management of stroke

Answer 7

~ clopidogrel (or aspirin)
~ PPIs
~ high intensity statins (atorvastatin)