TIA and strokes

Question 1

What do you give if clopi is contraindicated

Answer 1

Di - pyrid - a - mole

Question 1

Management of ischemic stroke vs thrombotic stroke

Answer 1

Ischemic - send to neurosurgeons
Thrombotic stroke - 300mg aspirin for 2 weeks then
If no AF - switch to 75mg clopidogrel and statin

Question 2

What if someone has a thrombotic stroke and they have AF

Answer 2

Don’t give antiplatelet after aspirin
Give anticoag - factor Xa inhibitor instead

Question 3

Why do you give apixaban or warfarin instead of clopidogrel if someone has AF and a thrombotic stroke

Answer 3

Essentially you want to prevent any clots forming in the first place. Aka you want to stop the coagulation cascade from activating any platelets and forming fibrin deposits via the final common pathway.

Question 4

What does aspirin do?

Answer 4

Stop any new platelets from aggregating

Question 5

What can we do about the clot which has already formed?

Answer 5

If <4.5hr since stroke, give ALTEPLASE for thrombolysis
<6 thrombectomy