Stroke
DAPT after an ischemic stroke or TIA?
New data will raise questions about optimal use of short-term dual antiplatelet therapy (DAPT) after an ischemic stroke or TIA. We know that short-term DAPT, such as aspirin plus clopidogrel for 21 days, reduces recurrent stroke risk compared to aspirin alone. But most evidence is with starting DAPT within 24 hours. And data are mostly for patients with a minor st…
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Stroke
Guide safe use of antiarrhythmics for atrial fibrillation
As a clinical pharmacist, you will see antiarrhythmics used more often for “rhythm control” in some patients with atrial fibrillation. Older data found that reducing frequency and duration of atrial fibrillation with antiarrhythmics doesn’t reduce mortality versus rate control with beta-blockers, CCBs, and may increase hospitalizations. …
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Tenecteplase
Do your part as a PHARMACIST in acute strokes
Clinicians will sort through new evidence looking for the best ways to bust clots in patients with acute ischemic stroke . Optimal stroke care is a big focus. The Joint Commission looks at whether patients get IV alteplase ( Activase ) appropriately and Medicare penalizes excess 30-day stroke readmissions. We know that one patient will have minimal or no disability …
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Tenecteplase
Acute stroke protocol update
The treatment of acute ischemic stroke will change due to new American Heart Association and American Stroke Association guidelines. Help update your hospital's screening and treatment protocols... Strive for faster turnaround times in stroke patients. For example, aim to rule out a hemorrhagic stroke with brain imaging within 20 minutes even though the qualit…
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TIA
Start with HIGH-dose atorvastatin after stroke
New evidence will spark questions about whether to aim for an LDL goal in patients with a prior ischemic stroke or TIA . For several years, we’ve been using target DOSES of statins shown to reduce cardiovascular (CV) risk rather than titrating to an LDL goal. Now data suggest treating to an LDL below 70 mg/dL instead of about 95 mg/dL prevents a re…
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TIA
Don’t use ticagrelor PLUS aspirin after stroke
As a hospital pharmacist, you will hear ticagrelor ( Brilique, Brilinta ) plus aspirin promoted after a MINOR ischemic stroke or high-risk TIA. New evidence shows that taking this combo for 30 days after a minor stroke or high-risk TIA decreases the composite of death or stroke in 1 in 91 patients, compared to aspirin monotherapy. But the benefit is mostly fro…
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Stroke
Clinical pharmacology of DOACs
Mechanism of action ㅡ Direct Oral Anticoagulants (DOACs) or Non-Vitamin K Antagonist Oral Anticoagulant (NOACs) are Direct Thrombin Inhibitors (e.g., Dabigatran) and Factor Xa Inhibitors (e.g. Rivaroxaban, Apixaban, Edoxaban) with prothrombinase activity, thus inhibiting the conversion of prothrombin to thrombin, see figure 1 . Thrombin c…
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TIA
Think of “ABCs” to optimize medications after stroke
Questions are coming up about reducing risk of RECURRENT ischemic stroke. Continue to focus on optimizing the “ABCs”. These key elements—Aspirin (or other antiplatelet agents), Blood pressure control, and Cholesterol management—are essential components in a robust strategy aimed at preventing subsequent strokes... Antithrombotics Recommend asp…
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Tenecteplase
Tenecteplase versus Alteplase for ischemic stroke
As a hospital pharmacist, you'll hear about more hospitals switching from alteplase ( Activase ) to tenecteplase ( TNKase ) to treat acute ischemic stroke. Tenecteplase is easier to give. It's a single IV push, due to its longer half-life rather than a bolus plus 1-hour infusion for alteplase. This may also speed up transfers for patients who need thrombecto…
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Stroke
Antiplatelets options for recurrent ischemic stroke
Antiplatelets medications ㅡ The preferred options of antiplatelets for recurrent ischemic stroke are aspirin, clopidogrel ( Plavix ) or combination of aspirin and clopidogrel for short term then followed by EITHER aspirin or clopidogrel alone. Dipyridamole ER/aspirin ( Aggrenox ) can be used. Non-preferred options include aspirin plus ticagrelor ( Brilique ), Ticlop…
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Tenecteplase
Alteplase for ischemic strokes in patients on oral antithrombotics
An important question, when to use tissue plasminogen activator (tPA) like alteplase for ischemic strokes in patients on oral antithrombotics (warfarin, etc)?! With stroke, "time is brain"... Giving tissue plasminogen activator (tPA) within 3 hours of stroke symptoms can increase the chance of a good recovery and reduce disability. Some patients also benefi…
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