Cerebrovascular Accident

Management

Thrombolysis

Contraindications

Risk of intracranial haemorrhage

Previous intracranial haemorrhage

Intracranial neoplasm

Suspected subarachnoid haemorrhage

Stroke or traumatic brain injury in preceding 3 months

Lumbar puncture in preceding 7 days

Risk of haemorrhage

Active haemorrhage

- Gastrointestinal haemorrhage in preceding 3 weeks

Oesophageal varices

Seizure at onset of stroke

Pregnancy

Hypertension >200/120mmHg

300mg aspirin stat PO/PR once CT has excluded haemorrhagic stroke
Hypertension should not be lowered in the acute phase following CVA

Prior to discharge

Antiplatelet agents

2 weeks of aspirin, thereafter clopidogrel 75mg PO OD.

Aspirin + dipyridamole (MR) may be used if clopidogrel is not tolerated / contraindicated

If atrial fibrillation (AF) is present, anticoagulants should not be started until 2 weeks after the onset of ischaemic symptoms

Statin (wait until 48 hours after CVA)

Complications

SIADH

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