Ischemic stroke is a medical emergency that requires immediate evaluation and treatment. During the acute phase following stroke, the goal of therapy is reperfusion of the ischemic area with thrombolytic therapy. Blood pressure (BP) goals during the first 24 hours depend on eligibility
for tissue plasminogen activator (tPA). Following the acute phase, therapy is directed at prevention of recurrent stroke with antithrombotics and control of ischemic-stroke risk factors. This is a case of a 79-year-old female with newly diagnosed atrial fibrillation who was inappropriately
started on aspirin for anticoagulation despite her high risk for stroke. She subsequently suffered a cardioembolic stroke. The patient was not a candidate for tPA because of the inability to determine when symptom onset occurred. Supportive care focused on BP and glycemic control as well as
venous thromboembolism prophylaxis. Secondary prevention of stroke for this patient included treatment of hypertension, diabetes, and hypercholesterolemia as well as initiation of warfarin. Abbreviations: ACE = Angiotensin converting enzyme, AF = Atrial fibrillation, AIS = Acute
ischemic stroke, aPTT = Activated partial thromboplastin time, BP = Blood pressure, CT = Computed tomography, DBP = Diastolic blood pressure, DVT = Deep-vein thrombosis, ECG = Electrocardiogram, ESR = Erythrocyte sedimentation rate, Hct = Hematocrit, Hgb = Hemoglobin, INR = International normalized
ratio, LDL = Low-density lipoprotein, LMWH = Low-molecular weight heparin, MCA = Middle cerebral artery, PE = Pulmonary embolism, Plt = Platelets, PT = Prothrombin time, SBP = Systolic blood pressure, TIA = Transient ischemic attack, tPA = Tissue plasminogen activator, TSH = Thyroidstimulating
hormone, VTE = Venous thromboembolism. Consult Pharm 2009;24:903-9.
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