Stroke Part II (Final) Flashcards
this is the most common arrythmia in practice
a-fib
the most serious common complication of a-fib is ________________; the most clinically evident thromboembolic event is ischemic stroke.
the abnormal rhythym results in blood that is not forcefully moved out of these chambers. the blood that remains in the atria becomes “sluggish” or static, which allows blood clots to form
arterial thromboembolism
true or false: stroke prophylaxis is indicated in patients with a-fib
true
-a-fib patients have overall average >5% risk per year of developing stroke, therefore prophylaxis is indicated (risk level varies risk factors)
what are two other sources of cardiogenic embolism besides a-fib which may result in acute ischemic stroke?
- mechanical heart valves
- bioprosthetic valves
true or false: both mechanical heart valves and bioprosthetic valves are an indication for OAC
false
-mechanical heart valves: require lifelong anticoagulation: warfarin is DOC
-bioprosthetic valves: less thrombogenic therefore do not require OAC, may need antiplatelet tx
what is meant by “valvular” a-fib?
a-fib in the presence of mechanical prosthetic valve or moderate-severe mitral stenosis (narrowing of mitral valve)
what is the DOC for valvular a-fib and for patients who have a mechanical heart valve w/o a-fib
warfarin
true or false: OAC are better for stroke prevention than ASA in non-valvular a-fib
true
(DOACs>warfarin)
note: only time warfarin is better is for VALVULAR a-fib
which DOAC is superior to the others in terms of stroke prevention in a-fib
apixiban
true or false: all DOACs increase the risk of intracranial hemorrage
false - all decrease
key feature for DOACs compared to warfarin
true or false: stroke prevention is done separately from rate/rhythym control in patients with a-fib
false - usually done in conjunction
in the process for Stroke Prevention in A-Fib (SPAF), you need to determine your patients risk of stroke. how is this done?
CHADS2
C - congestive HF (1 pt)
H - hypertension (1 pt)
A - age > 75 (1 pt)
D - diabetes (1 pt)
S2 - stroke (2 pts)
true or false: when using the CHAD-65 risk tool, if the patient is over 65 they need OAC
true
true or false: when using the CHAD-65 risk tool, if the patient is less than 65 they need OAC
false - need to assess for prior stroke, htn, dm and CHF
true or false: when using the CHAD-65 risk tool, if the patient is less than 65 but has had a prior stroke or has hypertension or has DM, or heart failure they need OAC
true
true or false: when using the CHADS-65 risk tool, if the patient is lessthan 65 and has NOT had one of the following:
- prior stroke or
- hypertension or
- diabetes or
- congestive heart failure
they need OAC
false
true or false: when using the CHADS-65 risk tool, if the patient is less than 65 but has coronary or peripheral heart disease they need OAC
true
true or false: when using the CHADS-65 risk tool, if the patient is less than 65 but does not have coronary or peripheral heart disease they need OAC
false
in the process for Stroke Prevention in A-Fib (SPAF), you need to determine your patients risk of bleeding. how is this done?
HAS-BLED
H - hypertension (sys > 160 & on treatment)
A - abnormal renal function
A - abnormal liver function
S - stroke in past
B - prior major bleeding or predisposition to bleeding
L - labile INRs
E - elderly
D - drugs (med use predisposing to bleeding e.g. NSAIDs, antiplatelets)
D - drugs (concomitant alcohol intake > 8 drinks/week)
this score than then be used to predict the % of major bleeds /yr
what needs to be monitored when a patient is taking a DOAC (DOAC monitoring checklist)
h”ABCDE”
H - health status (new medical conditions / upcoming procedures)
A - adherence (refills, missed doses, taking properly)
B - bleeding and risk factors for bleeding (bleeding episodes, Hgb, alcohol, falls, elevated blood pressure)
C - CrCl / renal failure (medication changes, dehydrating illness, lastest SCr/GFR)
D - drug interactions (antiplatelets, NSAIDs, other medications affecting DOAC levels)
E - examination / assessment (e.g. BP controlled)
what are some potential causes of an ischemic stroke in a patient receiving OAC
- inadequate intensity of anticoagulation
- suboptimal medication adherence
- alternate stroke etiology
- suboptimal risk factor management (e.g. HTN, DM, dyslipidemia)
true or false: if a patient has a stroke when they have already been recieving OAC, ASA may be added
false - in this scenario, OAC should be continued or switched to another agent. addition of ASA is not recommended
how long after a patient has a brief TIA with negative imaging should OAC be initiated
24 hrs
how long after a patient had a minor ischemic stroke should OAC be initiated
3 days
