TheABCsofSecondaryStrokPrevention：卒中二级预防的基本知识

1、the abcs of secondary stroke preventionchris shaffer, fnpmmp neurology/mmc inpatient neurology consult servicemaine nurse practitioner association annual conferencemay 1, 2014welcome to the mnpa 2014 conference it is a distinct honor to present to you, my esteemed peers!disclosures i am employed by

2、maine medical partners neurology and maine medical center, dept. of medicine i have no financial interest in any of the information presented todayobjectives participants will understand: 1. indications for antiplatelet therapy and anticoagulation post- ischemic- stroke 2.blood pressure goals post-s

3、troke 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 fibrillati

4、on- the elusive arrhythmia pfo- what to do? asa? atrial septal aneurysm? age? recommend reversal after ich, sah, sdh, consider resuming after 1-2 weeks atrial fibrillation: atrial fibrillation 2.7 million americans have afib! afib is associated with a 5-fold increase in stroke risk 15% of all stroke

5、s are from afib.hypertension hypertension: 72 million americans (2011) have htn: 140/90 acei/arb + thiazide diuretic most protective against stroke what should the ideal bp be in your post-stroke patient?diabetes: diabetes: 25.8 americans have diabetes. what should the hba1c be for post-stroke patie

6、nts?womens issues: its a girl thing: 9 million women die each year from heart disease worldwide pregnancy and cancer are pro-thrombotic states and we often overlook s/sx tia and stroke in those populationsdrugs, fats, and alcohol: hyperlipidemia: ldl should be 100, ideally 30 increases stroke risk (

7、duh) quit tobacco and secondary exposure etoh- the j curvemonday morning call you are notified that a patient of yours is being discharged form the hospital after having an ischemic stroke. when should you schedule this follow-up appointment? what will you address at this visit?what lab tests are im

8、portant?bmp vs cmpflphba1cwhen? why? how often?clinical resourcesaha/asa get with the guidelines :guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke associationdr. jane morris and dr. john belden, stroke experts, mmp neurology: 207-883-1414my expert nurse practitioner colleagues at mmp neurology:georgeann dickeyjason aucoin