Dabigatran o. Direct thrombin inhibitor 00 Dose 150 mg twice daily Reduce dose 75 mg twice daily in renal dysfunction 32o Don't open capsule -increases bioavailability by 75% a:. Monitoring not needed Dabigatran Warfarin Stroke(%/yrs 1.11 1.69** Major bleeds(%/yr) 3.11 3.36 *0<0.001 KENTUCKY Connoly S), et al. N Engl J Med 2009; 361: 1139-51 College of Pharmacy
Dabigatran • Direct thrombin inhibitor • Dose 150 mg twice daily – Reduce dose 75 mg twice daily in renal dysfunction • Don’t open capsule – increases bioavailability by 75% • Monitoring not needed **0<0.001 Connoly SJ, et al. N Engl J Med 2009;361:1139-51. Dabigatran Warfarin Stroke (%/yrs) 1.11 1.69** Major bleeds (%/yr) 3.11 3.36
Preventing Second Infarct o. Treat Tia as a first infarct o:. Carotid endarterectomy or stenting for 70 99% stenosis (50-69%, depends on age, sex and comorbidities o000oc0= Antiplatelet therapy Then th Anticoagulation Plaque is removed Carotid artery the carotid artery. o Mayo. Foundation for Medical Education and Research. All nights reserved. KENTUCKY College of Pharmacy
Preventing Second Infarct • Treat TIA as a first infarct • Carotid endarterectomy or stenting for 70- 99% stenosis (50-69%, depends on age, sex, and comorbidities) • Antiplatelet therapy • Anticoagulation
Preventing Second Infarct oi:. Hyperlipidemic control 00 Statin Start if ldl≥100mg/dL Patients with atherosclerotic ischemic stroke without known coronary heart disease o000oc0= Target LDL 70 mg/dL or 50% reduction ok Hypertension therapy ACE inhibitor or diuretic Diabetes control KENTUCKY College of Pharmacy
Preventing Second Infarct • Hyperlipidemic control – Statin • Start if LDL ≥ 100 mg/dL • Patients with atherosclerotic ischemic stroke without known coronary heart disease • Target LDL < 70 mg/dL or 50% reduction • Hypertension therapy – ACE inhibitor or diuretic • Diabetes control
Preventing Second Infarct ol:. Smoking cessation 0. Heavy drinkers should limit alcohol consumption to 2 drinks/ day for men and 1 当 drink/ day for women o 30 minutes of moderate-intensity physical exercise 1-3 times/week KENTUCKY College of Pharmacy
Preventing Second Infarct • Smoking cessation • Heavy drinkers should limit alcohol consumption to 2 drinks/day for men and 1 drink/day for women • 30 minutes of moderate-intensity physical exercise 1-3 times/week
Eab Antiplatelet Therapy -Aspirin Prevention of second stroke °ldea| dose is unknown Between 50-325 mg/day If patient has a stroke while on aspirin no o000oc0= evidence that increasing the dose will provide additional benefit Should be started in the first 48 hours KENTUCKY College of Pharmacy
Antiplatelet Therapy - Aspirin • Prevention of second stroke • Ideal dose is unknown – Between 50-325 mg/day – If patient has a stroke while on aspirin, no evidence that increasing the dose will provide additional benefit • Should be started in the first 48 hours