ISCHAEMIC STROKE

Question 1

Q: What is the recommended duration of dual antiplatelet therapy with aspirin and clopidogrel for ischaemic stroke?
A: Dual antiplatelet therapy with aspirin and clopidogrel is recommended for up to 21 days after ischaemic stroke.

Question 2

Q: Are there any contraindications for the use of alteplase in ischaemic stroke?
A: Yes, there are several contraindications for the use of alteplase in ischaemic stroke, including recent major surgery, active bleeding, and a history of intracranial hemorrhage.

Question 3

Q: What are the common side effects of aspirin for ischaemic stroke?
A: Common side effects of aspirin for ischaemic stroke include gastrointestinal upset, bleeding, and bruising.

Question 4

Q: What other medications may be prescribed in addition to antiplatelet agents for ischaemic stroke?
A: Other medications that may be prescribed in addition to antiplatelet agents for ischaemic stroke include antihypertensive medications and statins.

Question 5

Q: What is the recommended duration of treatment with antiplatelet agents after ischaemic stroke?
A: Antiplatelet agents should be continued for at least 2 years after ischaemic stroke, or longer if there is a high risk of recurrent stroke.

Question 6

Q: What is the recommended approach for preventing recurrent stroke in patients with ischaemic stroke?
A: The recommended approach for preventing recurrent stroke in patients with ischaemic stroke includes lifestyle modifications, such as smoking cessation and a healthy diet, as well as appropriate medical management with antiplatelet agents, antihypertensive medications, and statins.

Question 7

Q: What is the recommended dose of aspirin for ischaemic stroke?
A: The recommended dose of aspirin for ischaemic stroke is 300 mg/day, which can be started as soon as possible after onset of symptoms.

Question 8

What is the first-line treatment for ischaemic stroke?
A: Aspirin is recommended as the first-line treatment for ischaemic stroke by NICE guidelines.

Question 9

Q: When is aspirin contraindicated for ischaemic stroke?
A: Aspirin is contraindicated in patients with a history of aspirin allergy or sensitivity, bleeding disorders, or active bleeding.

Question 10

Q: What is the role of antiplatelet agents in the treatment of ischaemic stroke?
A: Antiplatelet agents, such as aspirin, clopidogrel, and dipyridamole, are used to prevent further blood clots from forming and causing recurrent stroke.

Question 11

Q: When is dipyridamole used in the treatment of ischaemic stroke?
A: Dipyridamole is used as an alternative antiplatelet agent for patients who cannot tolerate aspirin or clopidogrel.

Question 12

Q: What is the recommended blood pressure target for patients with ischaemic stroke?
A: The recommended blood pressure target for patients with ischaemic stroke is <130/80 mmHg, which can help reduce the risk of recurrent stroke.

Question 13

Q: What is the role of statins in the treatment of ischaemic stroke?
A: Statins are used to lower cholesterol levels and reduce the risk of recurrent stroke in patients with ischaemic stroke.

Question 14

Q: What is the recommended approach for managing anticoagulant therapy in patients with ischaemic stroke?
A: Anticoagulant therapy should be managed carefully in patients with ischaemic stroke, as it can increase the risk of bleeding. NICE recommends consulting a specialist in stroke or anticoagulation for guidance.

Question 15

Q: What is the recommended approach for managing blood glucose levels in patients with ischaemic stroke?
A: Blood glucose levels should be closely monitored and managed in patients with ischaemic stroke, as hyperglycemia can worsen stroke outcomes.

Question 16

Q: What is the recommended approach for managing dysphagia in patients with ischaemic stroke?
A: Dysphagia, or difficulty swallowing, is common after ischaemic stroke and can increase the risk of aspiration pneumonia. NICE recommends early assessment and management of dysphagia to reduce this risk.

Question 17

Q: What is the recommended treatment for acute ischaemic stroke?
A: Alteplase is recommended if it can be administered within 4.5 hours of symptom onset and if intracranial haemorrhage has been excluded by appropriate imaging techniques. Treatment with aspirin should be initiated as soon as possible within 24 hours of symptom onset, provided that intracranial haemorrhage has been excluded.

Question 18

Q: When should anticoagulants be used in acute ischaemic stroke?
A: Anticoagulants are not recommended as an alternative to antiplatelet drugs in acute ischaemic stroke in patients who are in sinus rhythm, but may be indicated in patients who are symptomatic of, or at high risk of developing, deep vein thrombosis or pulmonary embolism.

Question 19

Q: When should warfarin sodium be given in the acute phase of ischaemic stroke?
A: Warfarin sodium should not be given in the acute phase of an ischaemic stroke.

Question 20

Q: What is the recommended treatment for patients with a disabling ischaemic stroke and atrial fibrillation?
A: Patients with a disabling ischaemic stroke and atrial fibrillation should receive aspirin for 2 weeks before being considered for anticoagulant treatment.

Question 21

Q: What is the recommended long-term treatment for patients following a transient ischaemic attack or an ischaemic stroke not associated with atrial fibrillation?
A: Long-term treatment with clopidogrel is recommended. If clopidogrel is contraindicated or not tolerated, patients can receive modified-release dipyridamole in combination with aspirin. If both aspirin and clopidogrel are contraindicated or not tolerated, then modified-release dipyridamole alone is recommended. If both modified-release dipyridamole and clopidogrel are contraindicated or not tolerated, then aspirin alone is recommended.

Question 22

Q: When should patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation be reviewed for long-term anticoagulant treatment?
A: Patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation should be reviewed for long-term anticoagulant treatment.

Question 23

Q: When are anticoagulants recommended in the long-term prevention of recurrent stroke?
A: Anticoagulants are not routinely recommended in the long-term prevention of recurrent stroke, except when atrial fibrillation or other indications are present.

Question 24

Q: What is the recommended approach for initiating statin therapy after stroke symptom onset?
A: A high-intensity statin should be initiated 48 hours after stroke symptom onset in patients not already taking a statin, irrespective of the patient’s serum-cholesterol concentration.

Question 25

Q: When should beta-blockers be used in the management of hypertension following a stroke?
A: Beta-blockers should not be used in the management of hypertension following a stroke, unless they are indicated for a co-existing condition.

Q: What lifestyle modifications should all patients with ischaemic stroke make?
A: All patients should be advised to make beneficial changes to diet, exercise, weight, alcohol intake, and smoking cessation.

Question 26

Q: What is warfarin and when is it used in the treatment of ischaemic stroke?
A: Warfarin is an anticoagulant that is not recommended in the acute phase of ischaemic stroke. It may be considered for long-term prevention of recurrent stroke in patients with atrial fibrillation or other indications.

Question 27

Q: What are the recommended anticoagulants for patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation?
A: Patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation should be reviewed for long-term anticoagulant treatment, with direct oral anticoagulants (DOACs) such as apixaban, dabigatran, edoxaban, or rivaroxaban being preferred over warfarin.

Question 28

Q: What is the recommended approach for initiating anticoagulant therapy after ischaemic stroke?
A: In patients with ischaemic stroke associated with atrial fibrillation, anticoagulant therapy should be started after 2 weeks of aspirin therapy, unless there is a compelling indication to start earlier. In patients with a disabling ischaemic stroke and atrial fibrillation, aspirin should be given for 2 weeks before considering anticoagulant treatment. Patients already receiving anticoagulation for a prosthetic heart valve who experience a disabling ischaemic stroke and are at significant risk of haemorrhagic transformation, should have their anticoagulant treatment stopped for 7 days and substituted with aspirin.

Question 29

Q: What are the common direct oral anticoagulants (DOACs) used for the prevention of recurrent stroke in patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation?
A: The common DOACs used for the prevention of recurrent stroke in patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation are apixaban, dabigatran, edoxaban, and rivaroxaban.

Question 30

Q: What is the recommended dose of apixaban for the prevention of recurrent stroke in patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation?
A: The recommended dose of apixaban for the prevention of recurrent stroke in patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation is 5 mg twice daily. In patients with two or more of the following characteristics: age ≥80 years, body weight ≤60 kg or serum creatinine ≥133 μmol/L, the recommended dose is 2.5 mg twice daily.

Question 31

Q: What is the recommended dose of dabigatran for the prevention of recurrent stroke in patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation?
A: The recommended dose of dabigatran for the prevention of recurrent stroke in patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation is 150 mg twice daily. In patients with creatinine clearance (CrCl) 30–50 ml/min, the recommended dose is 110 mg twice daily. In patients with CrCl <30 ml/min, dabigatran is contraindicated.

Question 32

Q: What is the recommended dose of edoxaban for the prevention of recurrent stroke in patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation?
A: The recommended dose of edoxaban for the prevention of recurrent stroke in patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation is 60 mg once daily. In patients with CrCl 30–50 ml/min, the recommended dose is 30 mg once daily. In patients with CrCl <30 ml/min, edoxaban is contraindicated.

Question 33

Q: What is the recommended dose of rivaroxaban for the prevention of recurrent stroke in patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation?
A: The recommended dose of rivaroxaban for the prevention of recurrent stroke in patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation is 20 mg once daily. In patients with CrCl 15–49 ml/min, the recommended dose is 15 mg once daily. In patients with CrCl <15 ml/min, rivaroxaban is contraindicated.