A 64yo man presents with a hx of left sided hemiparesis and slurred speech. He was absolutely
fine 6h after the episode. What is the most appropriate prophylactic regimen?
a. Aspirin 300mg for 2 weeks followed by aspirin 75mg
b. Aspirin 300mg for 2 weeks followed by aspirin 75mg and dipyridamole 200mg
c. Clopidogrel 75mg
d. Dipyridamole 200mg
e. Aspirin 300mg for 2 weeks
answer: B
Secondary Prevention of TIA
Aspirin 300mg for 2 weeks after stroke
then Aspirin 75mg/day + 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 after event
A case of TIA. Evaluate by ABCD2 score. If score is >4 then there is high risk of early stroke.
ReplyDeleteA = Age >60 = 1
B = BP >140 systolic and/or >90 diastolic = 1
C = Clinical features: Hemiparesis = 2; Slurred Speech w/o weakness = 1; other = 0.
D = Duration of symptoms: >60mins = 2; 10-59mins = 1; <10 = 0.
D = Diabetes = 1
High risk (ABCD2 >4) Rx:
1. Aspirin + MR dipyridamole + statin
key is C , clopidogrel 75mg is the best long term antiplatelet after TIA
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