What are the three main types of strokes
Haemorrhaging strokes - manage BP AND AVOID STATINS
Ischaemic - blood clot is moving
TIA- transient ischaemic stroke
Stroke is associated with the risk of??? What do we do with patients
- Stroke is associated with the risk of morbidity and mortality
- Transfer patients urgently to hospital to determine the type of stroke and initiate treatment
What are the symptoms:
- BE FAST!!!!!!!
- BALANCE
- EYES - Droopy
- FACE- drops
- ARMS - weak and floppy
- SPEECH- slow and slurred
- TIME - call 999 quick
Initially we start stroke patients on
- Initially start off on 300mg of ASPIRIN
- Clopidogrel immediately if Aspirin is not tolerated
- Following a confirmed diagnosis, patients should receive treatment for secondary prevention immediately
Initially atleplase 4.5…….
And what else???
Initially, Aleplase - within 4.5 hours for 24 hours
- Aspirin 300mg/clopidogrel 75mg OD for 14 days
How do we manage it long term? Not associated with AF:
Anti-platelets (non AF patients):
What is first lin,second line and third line???
1ST LINE- CLOPIDOGREL 75MG OD
2ND LINE - MR Dipyramidole and ASPIRIN
3RD LINE - MR Dipyramidole OR ASPIRIN
Anti coagulants for stroke associated with AF:
- Warfarin - anticoagulant for AF patients
Long term management:
ASAAAAP- how long after stroke do we initiate statin (obvs not haemo.)what is our target by?? What are all pts advised on
- Initiate a statin 48 hours after stroke
- Monitor blood pressure, target <130/80 mmHg and treat hypertension
- All pts advised on life style changes - modifying diet, weight, alcohol intake and smoking
AntiPlatelet vs Anti Coagulant
Anti platelet agents inhibit clot formation by preventing platelet activation and aggregation
Anti coagulants primarily inhibit the coagulation cascade and fibrin formation
When a patient has a suspected TIAAAA
1) Aspirin immediately - unless contraindicated (300mg)
2)Clopidogrel or other anti platelet
3) Dual anti platelet therapy for low bleeding risk patients - Clopidogrel and Aspirin or Ticagrelor and Aspirin
4) mono therapy unsuitable
Interactions OF PPI and CLOPIDOGREL
- Concurrent use of PPI may make clopidogrel less effective
- Evidence still shows that omeprazole and esomeprazole still a cause for concern
- Lansoprazole and other should be okay
Troponin elevated when
Stemi and nstemi
