A 64yo man has presented to the ED with a stroke. CT shows no hemorrhage. ECG shows atrial
fib. He has been thrombolysed and he’s awaiting discharge. What prophylactic regimen is best for him?
a. Warfarin
b. Heparin
c. Aspirin
d. Statins
e. Beta blockers
answer: A
Treatment of stroke
Immediate management:
If within 4-6hours of onset: Thrombolysis with rtPA e.g. alteplase (need a brain scan first, can't give if there is hemorrhagic stroke on CT)
Secondary Prevention
Aspirin 300mg for 2 weeks after stroke
then Clopidogrel 75mg/day for life....
/if contraindicated =dipyridamole (200 mg twice daily) and low dose aspirin....
/if dipyridamole also contraindicated = aspirin alone
If there is AF = Warfarin
If there is HTN = ACEI/Thiazide , start after discharge from hospital, aim for 140/90 or less
If DM = control
Is Smoking = Stop
Offer statin 48hrs following stroke
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