Dual antiplatelet therapy (DAPT) improves outcomes in patients with high-risk TIA or minor ischemic stroke

In patients with minor ischemic stroke or high-risk TIA, those who received a combination of clopidogrel and aspirin had a lower risk of major ischemic events but a higher risk of major haemorrhage at 90 days than those who received aspirin alone. However, the relative reduction in recurrent stroke occurred almost entirely during the first week, whereas bleeding events (most of which were not intracranial) were distributed fairly evenly throughout 90-day follow-up. Thus, it appears that one can maximize benefit and minimize harm by confining DAPT to just a few weeks 

TIA (Transient Ischaemic Attack)

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  • TIA is defined as a brief episode of neurologic dysfunction with no permanent infarction.
  • Head CT noncontrast is not reliable for acute ischemia, but it can find alternative conditions necessitating management. MRI with DWI displays greater diagnostic ability.
  • Risk scores that predict future stroke are not reliable when used alone.
  • Patients are typically admitted for inpatient management due to this risk of future stroke.

 

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TIA

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Cornerstones of treatment for TIA revolve around reducing the risk of future events with blood pressure control, lipid control, and antiplatelet agents. Blood pressure should be maintained at 140/90 with a thiazide diuretic and/or an ACE inhibitor. Statins should be given to keep LDL of under 100mg/dL or 70mg/dL in high risk patients. Niacin or gemfibrozil are recommended to maintain HDL above 40mg/dL. Antiplatelet agents include aspirin with or without dipyridamole, or clopidogrel alone.

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Central Retinal Artery Occlusion

  • Presentation: Painless vision loss
  • Early ophthalmology consultation (true eye emergency)
  • Should be treated as a stroke
  • Traditionally poor prognosis overall
  • Promising HBO experience thus far. Consider early consultation with an emergent hyperbaric treatment center if available

Serious reasons why your patient fainted…

If your patient presents with…

  1. Symptoms of arm ischemia or paresthesias with syncope – Subclavian steal syndrome
  2. Chest pain that is acute, radiates, tearing/sharp, involves symptoms above and below diaphragm with syncope – Aortic dissection
  3. Tachypnea, pleuritic chest pain, shortness of breath with syncope – PE
  4. Neurologic deficit with syncope – TIA/stroke
  5. Headache that is sudden in onset, maximal at onset, worst of life with syncope – Subarachnoid hemorrhage
  6. Minor trauma with head or neck pain and syncope – Carotid/vertebral artery dissection
  7. Abdominal/flank pain in older patient with syncope – Ruptured AAA