Stroke part 3 Flashcards
Antiplatelet therapy is the cornerstone of antithrombotic therapy for the secondary prevention of ischemic stroke and should be used in non-cardioembolic strokes
Aspirin, extended-release dipyridamole plus aspirin, clopidogrel, and ticagrelor are all recommended for secondary stroke prevention
For patients already taking aspirin at the time of a non-cardioemoblic ischemic stroke or TIA, there is no evidence that increasing the dose of aspirin is more effective at preventing additional strokes
The combination of two or more antiplatelet medications for secondary stroke prevention may be an option for select patients
Dual Antiplatelet Recommendations for Patients with Non-cardioembolic Ischemic Stroke
Minor stroke (NIHSS score ≤3)
Aspirin and clopidogrel should be initiated within 7 days
(ideally within 12-24 hours)
Continue for 21-90 days followed by single-agent antiplatelet therapy
Recent (<30 days) minor stroke or TIA attributable to 70-99% stenosis of a major intracranial artery
Aspirin and clopidogrel 75 mg daily for up to 90 days followed by single-agen antiplatelet therapy
Recent (within 24 hours) minor stroke or high-risk TIA and concomitant ipsilateral >30% stenosis of a major intracranial artery
Ticagrelor 90 mg twice a day may be added to aspirin for up to 30 days
Oral anticoagulation is the treatment of choice for the prevention of stroke in patients with atrial fibrillation and atrial flutter
CHA2DS2-VASc
Direct-acting Oral Anticoagulant Dosing Adjustments Required for Renal Impairment
Usual Oral Dosing for Stroke Prevention in
Atrial Fibrillation
5mg PO BID
apixaban
Direct-acting Oral Anticoagulant Dosing Adjustments Required for Renal Impairment
Usual Oral Dosing for Stroke Prevention in
Atrial Fibrillation
150 mg PO BID
Dosing adjustments:75 mg PO twice daily if creatinine clearance 15-30
mL/min
Dabigatran
Direct-acting Oral Anticoagulant Dosing Adjustments Required for Renal Impairment
Usual Oral Dosing for Stroke Prevention in
Atrial Fibrillation
Usual dosing:60 mg PO daily
Dosing adjustments:30 mg orally daily if creatinine clearance is 15-50 mL/min
Edoxaban
Usual Oral Dosing for Stroke Prevention in
Atrial Fibrillation
Usual Oral Dosing for Stroke Prevention in
Atrial Fibrillation
20 mg PO daily with food
Dosing adjustments:15 mg orally daily with evening meal if creatinine clearance is ≤50 mL/min
Before starting antiplatelets or anticoagulation you must wait 24 hours after administering a fibrinolytic
For adults with hypertension who experience a stroke or TIA, treatment with a thiazide diuretic, ACE inhibitor, or ARB is useful
For adults who experience a stroke or TIA, a BP goal of less than 130/80 mm Hg is recommended
