Stroke Etiology
Document stroke etiology required Large artery atherosclerosis Cardiac embolism Small Vessel disease Other determined etiology Dissection Hypercoagulability Other Cryptogenic Stroke Multiple potential etiologies Undetermined etiology Unspecified...
Acute Stroke 5 – after 24 hr
Check the following if not already done If TPA not given, document reason Antiplatelet if not contraindicated. Speech, Occupational, Physical therapy Lipid checked. Other pertinent lab done. High intensity Statin such as Atorvastatin 40-80 mg qd Diet Deep vein thrombosis prophylaxis Document Stroke type/etiology Rehab evaluation if indicated, if...
Screen for Stroke
For non neurologist Use in hospital setting with signs of acute stroke CP-SSS = Cincinnahttps://www.mdcalc.com/cincinnati-prehospital-stroke-severity-scale-cp-sss#use-casesti Prehospital Stroke severity Scaled Use in prehospital setting RACE – Rapid arterial oClusion Evaluation LAMS – Los Angeles Motor Scale...
Cerebellar hemorrhage
Consider surgical treatment if hemorrhage is over 3 cm in diameter, or volume over 15 cm square deteriorating neurologically or Brainstem compression or hydrocephalus...
NOAC associated bleeding
Time Anticoagulation effect resolved 5 half live since last dose Dabigatran (Pradaxa): 2.5 to 3.5 days Rivaroxaban (Xarelto): 1-2 days Apixaban (Eliquis): 1.5 to 3 days Management Discontinue medication Specific reversal agent Dabigatran: idarucizumab (Praxbind) initial dose 2.5 g iv, repeat in 20 min, total of 5 g Apixaban,...
Warfarin associated bleeding
For serious bleeding Discontinue Warfarin Vit K 10 mg slow iv over 20-60 minutes may repeat q12 ir inr still high Kcentra: PCC (4 factor prothrombin complex concentrate) – 1500 to 2000 units iv over 10 min...
Intracerebral hemorrhage (ICH)
Intracerebral Hemorrhage (ICH) Score Initial care airway cardiovascular support acute stroke care facility, ICU care Reversal of anticoagulation & coagulopathy Stop all anticoagulant and antiplatelet Heparin associated bleed Protamine sulfate: slow IV infusion (< 20 mg/minute and no more than 50 mg over any 10-minute period). Warfarin associated ICH:...
Diener Law
Resumption of anticoagulation after stroke/tia tia: immediate Mild stroke (nihss < 8): 3 to 5 days Moderate stroke (nihss 8-16): 5-7 days Severe stroke (nihss over 16): 2 weeks Reference huisman mv, et al. Thromb Haemost. 2012...
NOAC
Use of NOAC in atrial fibrillation FXa Inbibitor Eliquis (Apixaban) minimal interaction with cytochrome, 25% excreted renal Usual dose: 5 mg bid Use the lower dose of 2.5 mg bid, if 2 of following: over age 80 Creat over 1.5 weight <60 kg End stage renal disease: 5 mg...
Antiplatelet
Aspirin: • only agent established as effective for early treatment of acute ischemic stroke.• Should be given asap if no bleed• No Aspirin for 24 hours after tpa. Optimal dose not clear, 50 to 325 mg as effective as higher dose For Asian patients with high-risk TIA or minor...