Stroke Therapy Flashcards
What is the loss of neurons, synapses and axonal fibres with every minute that a large vessel ischaemic stroke is untreated?
1.9 million neurons
13.8 billion synapses
12km axonal fibres
What is the aim of thrombolysis?
To restore perfusion before cell death occurs
What are the risk factors for haemorrhage after thrombolysis?
Age Infarct size Vessel occlusion Diabetes Hypertension Stroke severity Tissue changes Antiplatelets
When does the benefit of alteplase outweigh the risk?
When used up to 4.5 hours after the onset of symptoms in accordance with the licence
What is the benefit of alteplase in stroke treatment dependent on?
Highly time-dependent
Minimising time to start of treatment is critical to ensuring the best possible outcome
What is the FAST treatment used for?
Stroke symptom recognition Calling for help Alerting hospital team Alerting CT/radiology team Keeping patient/relatives informed
What are the contraindications to thrombolysis?
Age - licence limited to < 80 y/o
Recent bleeding
Severe hypertension
When might heparin be used prophylactically?
In patients at moderate-high risk of DVT
In what patients might warfarin be used in combination with aspirin or clopidogrel?
In patients with a prosthetic heart valve
What is the most common serious adverse effect of warfarin?
Bleeding - benefit of anticoagulation must outweigh risk of serious bleeding
What are the contraindications to warfarin use?
Recent surgery
Pre-existing haemorrhagic state e.g. liver disease, renal failure, haemophilia
Pre-existing structural lesions e.g. peptic ulcers
Recent cerebral haemorrhage
Uncontrolled hypertension
What drugs does warfarin interact with?
Ciprofloxacin, clarithromycin, erythromycin, metronidazole, trimethoprim
Acetaminophen
Acetylsalicylic acid
NSAIDs
