Clinical Conversations: Acute Stroke Treatments and Secondary Stroke Prevention | Part Two

Clinical Conversations: Acute Stroke Treatments and Secondary Stroke Prevention | Part Two

 

Never before has it been so important to educate our patients about the importance of calling triple zero promptly if they have symptoms that could be a stroke as this will result in far better outcomes. The F.A.S.T. test should be displayed in all medical waiting rooms and hospitals. Professor Bruce Campbell explains the newest technology and medications used in acute stroke and secondary stroke prevention. This is part two of a two-part article.

This is part two of this series. Read Part 1 >>

Practice points

• If you get a focal deficit that is sudden onset (the average duration is about ten minutes,), the patient needs exactly the same workup as a stroke.
• Look at the carotid arteries, look for atrial fibrillation, start anti-platelet therapy really quickly. Brain imaging is very worthwhile, such as a CT scan to exclude a bleed; an MRI should be normal in a TIA.
• GPs need to ensure patients have adequate and appropriate secondary stroke prevention therapy.
• Look hard for atrial fibrillation, as anti-platelet therapies will not prevent stroke recurrence if the emboli are atrial in origin. It is definitely worth feeling the pulse every time you see the patient as a single Holter monitor has pretty low sensitivity.
• If you have a patient who’s had a normal Holter monitor, but you are suspicious that they really have had an embolic event, you can certainly take advice from your local stroke team.
• Dual anti-platelet therapy (aspirin and clopidogrel) is used for ischaemic stroke/TIA for three weeks and then clopidogrel is continued.
• The evidence is that we need to reduce the LDL to a target of less than 1.8 mmol/L.
• Reduce the blood pressure as low as you can get it without making the patient feel horrible, certainly a systolic consistently less than 140 mmHg.

DL
How how hard should we look for AF? I mean, would one or two negative Holter monitors be all that we need to do? Or do we need to actually look for longer periods, seeing that a lot of AF is asymptomatic?

BC
You’re absolutely right that AF is tricky to diagnose both because of the asymptomatic ...

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