Stroke Prevention and Treatment - Rush University Medical Center

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Patient after stroke or TIA Cardioembolic stroke Oral anticoagulants: 1. Warfarin 2. Dabigatran 3. Rivaroxaban RELY, NEJM 2009; ACTIVE NEJM 2009; ARISTOTLE NEJM 2010; ROCKET-AF NEJM 2010 Cardioembolic stroke - AFib Warfarin reduces risk of stroke by 68% Aspirin reduces risk of stroke by 21% Contraindication to warfarin? YES NO ©2003 RUSH University Medical Center Initiate Oral anticoagulant Initiate 1. aspirin or 2. clopidogrel/aspirin
Cardioembolic stroke - AFib • Patients with ischemic stroke or TIA with persistent or paroxysmal (intermittent) AF – Recommended: • Anticoagulation with adjusted-dose warfarin (target INR 2.5, range 2.0 to 3.0) (Class I, LOE A) • Patients unable to take oral anticoagulants – Recommended: Aspirin 325 mg per day (Class I LOE A) – Clopidogrel plus aspirin is slightly better than aspirin alone (RRR 11%) in those who are not eligible for warfarin (ACTIVE NEJM 2009; 360:2066-2078) • Direct thrombin and Factor Xa inhibitors (dibigatran, rivaroxaban) has lower embolic stroke risks than warfarin with similar hazards and less concern regarding monitoring and dose adjustment ©2003 RUSH University Medical Center
Page 1 and 2: Stroke Prevention and Treatment Shy
Page 3 and 4: Public health impact of stroke •
Page 5 and 6: • Knowledge is POWER Fixing the p
Page 7 and 8: What is a stroke? ©2003 RUSH Unive
Page 9 and 10: • Stroke as in “struck down”
Page 11 and 12: Brain Attack: Warning Signs ©2003
Page 13 and 14: Unilateral Paralysis • Weakness,
Page 15 and 16: Double vision • Perception of two
Page 17 and 18: Brain Attack: Risk Factors ©2003 R
Page 19 and 20: • High blood pressure (hypertensi
Page 21 and 22: ©2003 RUSH University Medical Cent
Page 23 and 24: • 6 of 10 Americans are overweigh
Page 25 and 26: Carotid artery stenting ©2003 RUSH
Page 27 and 28: Transient ischemic attack (TIA) •
Page 29: ED Acute Stroke Team Head CT ECG Ba
Page 33 and 34: Brain Attack: Treatment ©2003 RUSH
Page 35 and 36: % Favorable 50 40 30 20 10 0 Clot B
Page 37 and 38: Clot Retrievers ©2003 RUSH Univers
Page 39 and 40: Time to arrival: < 3 hours 68 (23%)
Page 41 and 42: Care at Primary Stroke Centers •
Page 43 and 44: Chicago • 2.8 million reside in C
Page 45 and 46: Illinois Law: HB2244 • Signed by
Page 47 and 48: IL IL LAKE LAKE 2 3 7 14 4 6 COOK C
Page 49 and 50: • Know your risk factors and ask

Stroke Prevention and Treatment - Rush University Medical Center

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