Eab Antiplatelet Agents vs Aspirin Prevention of stroke 23% ◇ Clopidogrel 25 21% P=0.006* CAPRIE: N=6.431 00 P=0.02* Ticlopidine 20 TASS: N=3.069 c15 ASAER-DP o000oc0= 8% EsPs2:N=3,299 10P=028 0 CAPRIE TASS ESPS-2 X F:Statistically significant KENTUCKY Adapted from Albers, et al. Chest. 1998: 114: 683S College of Pharmacy
Antiplatelet Agents vs Aspirin: Prevention of Stroke * Statistically significant. RRR (%) Clopidogrel CAPRIE: N = 6,431 Ticlopidine TASS: N = 3,069 ASA/ER-DP ESPS-2: N = 3,299 P = 0.02* P = 0.006* P = 0.28 CAPRIE TASS ESPS-2 0 5 10 15 20 25 30 8% 21% 23% Adapted from Albers, et al. Chest. 1998;114:683S
Eab Limiting Damage from Infarct ● Heparin 00 Good data on outcomes not available Avoid in hemorrhagic stroke Dose to aptt of 1.5-2.0 times control o000oc0= No bolus ° Streptokinase Should be avoided due to excess mortality KENTUCKY College of Pharmacy
Limiting Damage from Infarct • Heparin – Good data on outcomes not available – Avoid in hemorrhagic stroke – Dose to aPTT of 1.5-2.0 times control – No bolus • Streptokinase – Should be avoided due to excess mortality
Tissue Plasminogen Activator oi Within 3 hours of symptoms o".. 3-month outcome significantly improved Intracereberal hemorrhage increased, but sE. no increase in mortality or disability 8·Dose09mg/kgⅳ(max90omg)with10%as a bolus, remainder over 1 hour KENTUCKY Hacke W, et al. N Engl J Med 2008; 259: 1317-29 College of Pharmacy
Tissue Plasminogen Activator • Within 3 hours of symptoms • 3-month outcome significantly improved • Intracereberal hemorrhage increased, but no increase in mortality or disability • Dose 0.9 mg/kg iv (max 90 mg) with 10% as a bolus, remainder over 1 hour Hacke W, et al. N Engl J Med 2008;259:1317-29
Tissue Plasminogen Activator Exclusion criteria 6l: 0-3 Hour Criteria 3-4.5 Hour Additional Criteria O:, Intracranial or subarachnoid bleeding(orh×) Taking any anticoagulant o'. Other active internal bleeding NIHSS Score >25 Recent intercranial surgery, Previous stroke and head trauma, stroke o000oc0= diabetes ÷· Blood pressure>185/110 Seizure at stroke onset °Age>80 years 了· Intracranial neoplasm,AV malformation aneurysm Active treatment with warfarin, heparin or platelets <100.000 KENTUCKY Del Zoppo, et al. Stroke 2009: 40: 3945-8 College of Pharmacy
Tissue Plasminogen Activator Exclusion Criteria 0-3 Hour Criteria • Intracranial or subarachnoid bleeding (or hx) • Other active internal bleeding • Recent intercranial surgery, head trauma, stroke • Blood pressure > 185/110 • Seizure at stroke onset • Intracranial neoplasm, AV malformation, aneurysm • Active treatment with warfarin, heparin, or platelets <100,000 3-4.5 Hour Additional Criteria • Taking any anticoagulant • NIHSS score >25 • Previous stroke and diabetes • Age > 80 years Del Zoppo, et al. Stroke 2009;40:3945-8
Eab Blood Pressure management in Acute Stroke If not eligible for tPA 00 SBP<220 or DBP<120- no treatment SBP>220 or dBp=121-140 Labetalol o000oc0= Nicardipine DBP >140 Nitroprusside KENTUCKY College of Pharmacy
Blood Pressure Management in Acute Stroke • If not eligible for tPA – SBP < 220 or DBP < 120 – no treatment – SBP > 220 or DBP = 121-140 • Labetalol • Nicardipine – DBP > 140 • Nitroprusside