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CVA (Subsequent management (Aspirin - if thrombolysed delay for at least…
CVA
Subsequent management
Aspirin - if thrombolysed delay for at least 24hrs
Routine use of anticoagulation is not recommended
Monitoring and maintenance of normal parameters
Ongoing neuro assessment
Discuss with family - prognosis
Immediate management
Refer to stroke team
Attention to ABC (National stroke foundation recommend treating hypertension if >220/120)
Investigation - CTB to confirm or exclude haemorrhage and confirm dx
Definitive management - Options
IV thrombolysis
Most evidence for IV recombinant tissue plasminogen activator (Alteplase)
Reduces death and disability but is associated with a risk of intracranial haemorrhage
Indications - Ischaemic stoke of <4.5 hrs duration (CT shown no haemorrhage or any non vascular cause for stroke)
Contraindications - stroke or head trauma within 3/12, hx intracranial bleed, major surgery within 14 days, GI/GU haemorrhage within 30 days, MI within 30 days, HTN>180/110, Coagulopathy, seizure at onset of stroke)
Mechanical thrombectomy
Requires specialist expertise
Risk of vascular damage or dissection with potential worsening symptoms
Indications - ischaemic stroke in a large vessel, failure or CI to thrombolysis or outside time window
Contraindications - tortuous vessels, pre-existing coagulopathy, established infarct on CT, contrast allergy
Intra-arterial thrombolysis
Requires selective catheterisation of the target vessel and delivery of a concentrated dose of thrombolysis
Greater rates of recanulisation but no evidence this impacts death or disability
Indications - Ischaemic stroke <6 hrs duration, CI to IV thrombolysis (e.g. recent surgery)