PHRM 211 Lecture Notes - Lecture 29: Apixaban, Vitamin K, Loading Dose
Document Summary
Ischemic stroke and acute intracerebral hemorrhage (part 3) Aspirin is the standard antithrombotic therapy for most stroke patients. Starting aspirin asap reduces risk of early recurrent ischemic stroke. Giving asa within 24 hours of tpa increases risk of ich. Immediately after initial ct scan excludes hemorrhagic stroke. For patients receiving tpa, delay asa until a ct scan done 24 hours after tpa excludes hemorrhagic stroke/transformation. Loading dose : 160 mg if patient not already on an antiplatelet and not receiving tpa. Maintenance dose : asa 81-325 mg daily indefinitely. Alternative to aspirin with similar efficacy and tolerability (caprie trial), consider if aspirin allergy/intolerance. More efficacious than aspirin alone (rrr 20%, esprit and esps-2 trials) but headache, more expensive ( a day, requires special authority) Contraindicated in patients with a history of stroke or tia, as these patients had higher risk of thrombotic and hemorrhagic strokes in triton-timi 38, and no longer available on canadian market.
