How do you treat a TIA?
- Aspirin 300mg STAT
2. secondary prevention + long term clopidogrel
Initial management of an ischemic stroke
- If <4.5 hours presentation give Alteplase
2. Aspirin 300mg for 2 weeks + PPI
Why is Warfarin NOT to be given during an ischemic stroke?
Risk of haemorrhagic transformation
If a stroke patient also has AF how long should they receive aspirin for before considering anticoagulation treatment?
2 weeks
If a stroke patient has a prosthetic valve and is therefore being treated with Warfarin - what do you do with the anticoagulation?
Stop for 7 days - give Aspirin along
Should hypertension be treated during a stroke?
No - risk of reducing cerebral perfusion so only initiate if patient is in hypertensive crisis
Long term management of a stroke
- Clopidogrel (if no AF) or Warfarin (if AF)
- High intensity statin
- antihypertensives (aim for 130/80) - avoid beta blokers
- Lifestyle
BP aim post stroke
130/80mmHg
Initial management of intracerebral haemorrhage
1, Surgical intervention to remove haemotoma
- Rapid BP lowering therapy if systolic between 150-220mmHg
- Anticoagulation to be stopped + reversed
Long term management of intracerebral haemorrhage
- Avoid aspirin or anticoagulation
- BP monitoring to avoid hypoperfusion
- Avoid statins
- Hollistics e.g. swallow function. nutritional supplements etc
