Stroke Guidelines (NICE) Flashcards
What scan should you consider for patients who have had a TIA after specialist assessment?
MRI same day
NOT CT
What should everyone who has had a TIA and could be a candidate for carotid endarterectomy have?
Carotid imaging (doppler?)
What scan is done for patients with acute stroke?
Non-contrast CT
What scan is done after non-contrast CT in patients who are candidates for thrombectomy?
CT angiography
What needs to be excluded before giving thrombolysis and how is this done?
Haemorrhage
Non-contrast CT
What is the time limit from symptom onset to giving thrombolysis?
4.5 hours
When should thrombectomy aim to be performed?
Within 6 hours of stroke onset
Should you give both thrombolysis and thrombectomy?
Yes
What area of the circulation needs to be blocked for thrombectomy to be appropriate?
Proximal anterior circulation
From 6-24 hours after symptom onset, when should thrombectomy be carried out?
If there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume
What medication should be offered to people as soon as possible after stroke?
Aspirin 300mg
How long should aspirin continue after acute stroke?
2 weeks
What is the initial management of acute cerebral venous sinus thrombosis (including secondary haemorrhage)?
Full-dose anticoagulation treatment (initially full-dose heparin and then warfarin [international normalised ratio 2 to 3])
For people with acute stroke and AF, what is the medical management?
Aspirin 300mg two weeks before considering anticoagulation
Management for stroke with symptomatic DVT or PE
Anticoagulation treatment in preference to treatment with aspirin unless there are other contraindications to anticoagulation
Should you immediately treat a stroke with a statin?
No
Continue with statin if already on it
When should patients with acute intracerebral haemorrhage have rapid blood pressure lowering?
If within 6 hours of onset and systolic BP 150-220
OR
After 6 hours with systolic BP >220
Should BP be routinely lowered for patients with acute ischaemic stroke?
No
Only if hypertensive crisis
If undergoing thrombolysis consider lowering to below 185/110mg
What is the preferred long term anti-platelet management for ischaemic stroke or TIA?
Clopidogrel 75mg daily
What is the second line long term anti-platelet management for ischaemic stroke or TIA if clopidogrel cannot be tolerated?
Modified–release dipyridamole (200 mg twice a day) combined with low dose aspirin
Acute TIA medical management
300mg aspirin
Should lipid lowering be done on patients who have had a stroke or TIA?
Yes high dose statin
Do you give clopidogrel long term for patients with stroke with associated AF?
No
What anticoagulants do you give for stroke in a patient with AF and when?
14 days after stroke
DOAC
What degree of stenosis can be considered for carotid endarterectomy (2 different guidelines)?
> 70% according ECST criteria
50% according to NASCET criteria
