Stroke Archives - Page 19 of 20 - Clinical Advisor

Stroke

Aspirin guidelines push stroke prevention

New recommendations call for at-risk men aged 45-79 years to take aspirin daily to prevent a primary heart attack. Similarly, at-risk women aged 55-79 years should take aspirin to prevent a primary ischemic stroke.

CT showing a large infarct in the left hemisphere of a stroke patient

t-PA increases intracranial hemorrhage, but functional outcomes are inconsistent

Level 1: Likely reliable evidenceThe randomized placebo-controlled European Cooperative Acute Stroke Study III (ECASS III) evaluated alteplase (Activase, tissue-type plasminogen activator [t-PA]) in 821 patients aged 18-80 years with acute ischemic stroke (N Engl J Med. 2008;359:1317-1329). Alteplase 0.9 mg/kg (up to 90 mg) or placebo was given IV within 3-4.5 hours of non-severe stroke…

Post-stroke anticoagulation?

An elderly man with a remote history of hemorrhagic stroke has a new deficit consistent with cerebrovascular accident. His chart says anticoagulation is contraindicated. CT is negative for hemorrhage. Can some anticoagulation, in particular, clopidogrel (Plavix), be used?—Edib Korkut, MD, Alexandria, La. This case raises several important issues. The history of the prior hemorrhagic stroke…

CRP vs. LDL as a stroke predictor

In my practice, C-reactive protein (CRP) appears to be better than LDL at predicting such ischemic events as infarcts or strokes. Among my patients at high risk for ischemic events, those treated with rosuvastatin and simvastatin seem to do better than those taking other statins. (Those taking the ACE inhibitor ramipril also do well, but…

Stopping meds post atrial fibrillation flutter

How long should a patient whose cardiac chambers show no evidence of enlargement remain on antiarrhythmic and anticoagulation medications after conversion from atrial fibrillation flutter to sinus rhythm?—NELSON C. YU, MD, Baxter, Ky. If this was an isolated instance, two weeks will do. If this is a recurrent problem, consideration should be given to continued…

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