Stroke 2014: Stroke Prevention

Question 1

If stroke/TIA caused by 50 - 99% stenosis of a major intracranial artery, preferred antithrombotic therapy is

Answer 1

Aspirin 325 mg > warfarin

Question 2

When is it reasonable to start anticoagulation after the onset of neurological symptoms?

Answer 2

Within 14 days (2 weeks)

Unless high risk hemorrhagic conversion in which case it is reasonable to delay initiation beyond 14 days

Question 3

If stroke/TIA within 30 days, what agent, dose, and duration can be added on to ASA (if 70 - 99% stenosis of a major intracranial artery)

Answer 3

Clopidogrel 75 mg daily for 90 days

Question 4

If mechanical valve + history of stroke/TIA prior to its insertion + low bleeding risk, recommended antithrombotic therapy is

Answer 4

warfarin + ASA 81 mg daily

Question 5

If mechanical valve + stroke/TIA after antithrombotic therapy, depending on bleeding risk, it is reasonable to

Answer 5

Intensify therapy by increasing target INR or increasing ASA dose to 325 mg

Question 6

If noncardioembolic ischemic stroke or TIA, antithrombotic agents of choice

Answer 6

antiplatelet agents over oral anticoagulants

Question 7

Although rtPA is an approved treatment for acute ischemic stroke, it is best given if

Answer 7

On warfarin and INR is below 1.7
Dabigatran with a normal aPTT and last intake > 48 hours previously

“Systemic thrombolysis is contraindicated in patients on therapeutic OAC.” -2016