Prevention and Treatment of Cardioembolic Stroke: A Case Study

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Abstract:

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.

Keywords: Atrial fibrillation; Cardioembolic stroke; Case study; Ischemic stroke; Stroke; Stroke prevention

Document Type: Research Article

DOI: http://dx.doi.org/10.4140/TCP.n.2009.903

Publication date: December 1, 2009

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  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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