Medications After a Stroke

Tweety, BSN, RN · Jan 29, 2004

They may be afraid to coag due to his recent cardiac procedure and risk of bleeding?

Heparain is started if the CT scan is negative for a bleed in many cases, and coumadin is started asap until a therapuetic level is obtained.

Did his CT have brain swelling? That's unusual for a CVA and may be the reason he can't be anticoagulated. For swelling steriods like decadron would be used.

I've taken care of many a CVA patient, where ASA was the only thing given. Other drugs used aggrenox, plavix, coumadin, etc.

But the answer you gave in quotes is not accurate in every CVA patient. Thombolytics and anticoags are definately given in CVA patients.

Tweety, BSN, RN · Jan 29, 2004

Also, as you indicated his symtoms are improving. That is sometimes indicative that a lot of anticoagulation isn't warranted.

Each case is unique and it's not an exact science.

Best wishes.

Dragonnurse1, ASN, RN · Jan 29, 2004

Very slow bleeds will NOT show up on ct for up to 48 hours. Agressive tx after stroke can cause total bleed in brain with death being the result

Jay-Jay, RN · Jan 30, 2004

Originally posted by 3rdShiftGuy
Also, as you indicated his symtoms are improving. That is sometimes indicative that a lot of anticoagulation isn't warranted.

Each case is unique and it's not an exact science.

Best wishes.

Well, I guess that's the answer, Tweety. There was a patient across the hall from him who had also had a stroke, and HE was getting Heparin IV. I guess a lot also depends on the doctor, and what their favorite protocol is.

Roger did not have any serious bleeding following the angiogram. The angio site is clean and dry, and has only a very tiny amount of bruising. I've seen worse bruises from a clumsy blood draw! :) The cath lab nurse is to be commended.

Hubby continues to improve. They finally moved him out of the ER to the Rehab unit today, after 48 hours lying on a gurney (his butt was starting to get REALLY sore!). He is now able to grasp my hand and squeeze it almost hard enough to make me say 'ouch'! He can also bend the knee and flex the foot on the affected side.

zambezi, BSN, RN · Jan 30, 2004

Im sorry to read about your husband. The medications that I usually see patients put on post cva are aggrenox, plavix, or sometimes pletal. I hope he continues to improve.

PMHNP10 · Jan 30, 2004

Whatever happened to TPA? I remembered hearing about it during nursing school, but when I worked on a neuro unit after graduation, I never saw a pt who had received TPA. 9 times outta 10 they were on a hep gtt. I'll never forget about one pt I got to take care of--pretty major right sided stroke (flaccid entire left side). After a week or so of heparin, she slowly started to regain motor control in the left side. Eventually, she returned close to her baseline. I always thougt that if you have a CVA of the magnitude this one appeared to be, you can pretty much count on providing comfort care, but this person was fortunate.

jenac · Jan 30, 2004

Jay-Jay, my dad had a stroke a few weeks ago. He was given ASA immediately (after a CT to rule out hemorrage), on a Heparin drip in ICU for a few days than Aggrenox (horribly expensive drug!). He also takes Lipitor and an Anti-HTN profilacticly at this point.

I myself wondered about TPA-but it was not given. I think it was withheld due to the questionable time frame of his stroke. He woke up on a Sunday morning with Aphasia and right sided weakness, so we really had no idea when exactley it occurred.

In his case- he was transfered to the Rehab. unit and discharged two days later with very mild deficits. His aphasia and disphagia (sp?)remains, with slight cognative effects. He has full use of his right side-with no paresis or even weakness. His balance is good- with minimal concerns. He was very, very lucky.

My prayers are with you and your husband right now. I know too well what your going through. The fact that he is improving is a wonderful sign. I wish you both the best.

Jena

Tweety, BSN, RN · Jan 30, 2004

jenac, sorry to hear about your dad. My condolences.

Tweety, BSN, RN · Jan 30, 2004

Originally posted by psychrn03
Whatever happened to TPA? I remembered hearing about it during nursing school, but when I worked on a neuro unit after graduation, I never saw a pt who had received TPA. 9 times outta 10 they were on a hep gtt. I'll never forget about one pt I got to take care of--pretty major right sided stroke (flaccid entire left side). After a week or so of heparin, she slowly started to regain motor control in the left side. Eventually, she returned close to her baseline. I always thougt that if you have a CVA of the magnitude this one appeared to be, you can pretty much count on providing comfort care, but this person was fortunate.

We have a tpa program where I work. But it is rarely given, although a lot of people are evaluated. It has to be within a certain time frame, the person can't have a whole lot of pre-existing medical conditions, can't be on certain meds, labs have to be certain values, ct of the brain is negative, on and on.

The risk of bleeding is high, because as was mentioned above, the ct may be negative one day and have a bleed 48 hours later. (Also, ischemia doesn't show up right away either.)

In my three years in neuro I got to give tpa once. The patient died two days later from a massive bleed. On our unit, although we've given it many times, I've seen symptoms completely disappear only once. Most have some improvement in symptoms or no improvement in symptoms. Very risky.

Hope this helps.

Jay-Jay, RN · Jan 30, 2004

jenac, sorry to hear about your dad, but that's really encouraging to hear about his outcome!! :):) TWO days, and he WALKED out of the hospital! WOW!

southern rn · Jan 30, 2004

Sorry to hear about your husband's stroke. If he was unable to take po asa then it should have been given as a suppository. The reason tpa wasn't an option would be because of the arterial stick with the angio. I see asa used primarily alot in my hospital, along with the other platelet antagonists already mentioned. Hopefully they can just transition him back to his coumadin later in the post stroke period since he was already on it. It may be an option in the future if he has to come off his coumadin for tests, procedures, etc; to be inpatient first, stop the coumadin and use heparin drip. I have seen this done sometimes too with high risk pts. who need their anticoags. good luck to you and hubby and hope he has a speedy recovery!