TheABCsofSecondaryStrokePrevention：卒中二级预防的基本知识.ppt

PFO occurs in 15-25% of all adults, consider if 55 years and stroke. Reverse coumdin with Vit K, FFP, heparin with protamine sulfate for ICH Insufficient data on PFO reversals, and anticoag. For PFO * Ave. onset-66 males, 76 females Prolonged cardiac heart monitor with auto-detect software x 30 days ? Inflammatory effect of stroke risk peri-surgically and peri-infection * JNC 7 BP goal 120/80, but new AHA guidelines ? Controversial ACEI effect aldosterone/renin which is associated with luminal damage as well as plaque formation * Mediterranean diet most recommended now- fish, olives, vegies, lower DM risk by 83% (BMJ) FS 140-180 in hospital GAMES trial glyburide protective? 7.0 or less * Low HDL- add niacin or gemfibrozil Men 2-drinks, women 1 per day max Exercise at least 30 min 1-3 times per week, geriatric function 150 min./week, cyclic intensity –man biking uphill may be assoc. w/ afib. * Within 1 week, by 30 days, after 6-8 week labs * The ABCs of Secondary Stroke Prevention Chris Shaffer, FNP MMP Neurology/MMC Inpatient Neurology Consult Service Maine Nurse Practitioner Association Annual Conference May 1, 2014 Welcome to the MNPA 2014 Conference It is a distinct honor to present to you, my esteemed peers! Disclosures I am employed by Maine Medical Partners Neurology and Maine Medical Center, Dept. of Medicine I have no financial interest in any of the information presented today Objectives Participants will understand: 1. Indications for Antiplatelet therapy and Anticoagulation Post- Ischemic- Stroke 2.Blood pressure goals post-stroke 3. Diabetes management goals post-stroke 4. Cholesterol goals post-stroke 5. Brief overview of new anticoagulation agents in addition to warfarin (pharmacology update) Antiplatelet Therapy Is Aspirin really enough? 81 vs 325 mg vs more? Does ASA fail? Anticoagulation Indications: Atrial Fibrillation- the elusive arrhythmia PFO- what to do? ASA? Atrial septal aneurysm? Age? Recommend reversal after ICH, SAH, SDH, Consider res