Stroke Flashcards
Risk of Stroke
CHA2DS2VASc C - Congestive Heart Failure or Left Venticular Dysfunction H - Hypertension A2 - Age over 75+ (2 points) D - Diabetes S2 - Previous Stroke or TIA (2 points) V - Vascular Disease A - Age 65 - 74 S - Sex (Male = 1 and Female = 2)
SCORE = 2 or more Treat with Anticoagulation (excluding just sex)
SCORE = 1 low risk and no need for anticoagulation.
New Onset AF stroke prevention
PARENTAL Anticoagulant
Diagnosed AF stroke prevention
Warfarin or NOAC/DOAC
VTE in PREGNANCY
Heparins with LMWH as preferred choice
Stop at labour onset.
Mechanical VTE Prophylaxis
Eh compression stockings
For patients schedule for surgery
Continue until sufficiently mobile
Pharmacological VTE prophylaxis
For HIGHT VTE risk patients undergoing general/orthopaedic surgery OR admitted to hospital as general medical patients (if C/I: offer mechanical)
Types: Parenteral Anticoagulants: - LMWH - Unfractionated Heparin in renal failure - Fondaparinux
NOACs/DOACs
- Prophylaxis AFTER knee/hip replacement surgery
- EDOXABAN: treatment and prevention of recurrent VTE
Duration of VTE Prophylaxis
General Surgery: 5-7 days or until sufficient mobility
Major cancer surgery in abdomen or pelvis: 28 days
Knee/hip surgery: extended duration
Treatment of VTE
LMWH Or Unfractionated heparin in renal failure for at least FIVE DAYS until INR at 2 or more for AT LEAST 24hrs
Start ORAL anticoagulant at the SAME TIME: usually Warfarin
Unfractionated Heparin
Shorter duration of action
Preferred choice if:
- high risk of bleeding
- renal impairment
Essential to measure Activated Partial Thromboplasyin Time
LMWH
eg Tinzaperin, Enoxaparin, Dalreparin
Longer duration of action
Generally preferred choice due to
- Lower risk of Osteoporosis and Heparin Induced Thrombocytopeonia
Used in pregnancy
S/E of Heparins
- ) HAEMORRHAGE - Withdraw heparin. If rapid reversal required provide ANITDOTE of PROTAMINE
- ) HYPERKALAEMIA
- ) OSTEOPOROSIS
4.) HEPARIN INDUCED THROMBOCYTOPOENIA
Monitor before treatment and if more than 4 days of use
Types of Stroke
H - Haemorraghic
I - Ischaemic Strokes
T - Tran
Initial Management of TIA (mini stroke)
Aspirin 300mg or Clopidogrel 75mg immediately (OD)
Initial Management of Ischaemic Stroke
ALTEPLASE within 4.5 hours (For 24hrs)
Then Aspirin 300mg or Clopidogrel 75mg OD for 14 days
Long Term Management of TIA & ISCHAEMIC STROKE with NON AF PATIENTS
ANTIPLATELETS
1.) Clopidogrel 75mg OD or MR dipyridamole 200mg + Aspirin if Clopidogrel is C/I
- ) MR dipyridamole 200mg (if Aspirin or Clopidogrel is C/I)
- ) Aspirin alone (if Clopidogrel & Dipyridamole are C/I)
Statins
Monitoring BP
Lifestyle changes
