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…
قراءة المزيدAs 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. …
قراءة المزيدAs a hospital pharmacist, you will be asked about spontaneous intracerebral hemorrhage (ICH) treatment , due to updated guidelines. Follow these points... Anticoagulant reversal. Use 4-factor prothrombin complex concentrate ( Kcentra ) for warfarin-related ICH when INR is 1.3 or higher, along with IV vitamin K to reduce risk of INR reb…
قراءة المزيدClinicians 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 …
قراءة المزيدThe 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…
قراءة المزيدNew 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…
قراءة المزيدAs 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…
قراءة المزيدMechanism 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…
قراءة المزيدQuestions 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…
قراءة المزيدAs 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…
قراءة المزيدAntiplatelets 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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