Medications After a Stroke

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.

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.

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

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.

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.

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

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

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.

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!

Originally posted by Jay-Jay

It's been a few years since I did my pregrad on a stroke unit. Are there any medications that are routinely given now after a CVA to help control the damage, and reduce the brain swelling?

My husband had a CVA this week, and about all they did was try to give him....ASPIRIN! (which he couldn't swallow anyway!) I mentioned coumadin (taking him off coumadin for an angiogram CAUSED the stroke in the first place!) and they said, "Oh, we don't do that because the damaged brain tissue is very delicate after a stroke, and it might bleed."

This ain't my area of nursing (obviously!) so your input would be appreciated!

There are different kinds of stroke (Acute Ischemic Stroke =clot which the pt across the hall must have had where heparin can be the protocol) and Intracerebral hemorrhage (ICH) a bleed (which more than likely is the one your spouse has). If your husband has a bleed and heparin is given. It could -I'm sorry to say end things for him very quickly. Pressure in the brain is relieved with a drug called Mannitol it's a diuretic for pressure in the head also Corticosteroids and Glycerol are two other drugs used for ICH for different reason. Mannitol As for blood thinners, I have no idea why any DR. still uses Heparin it's to time consuming and an antiquated drug. Lovenox is such a wonderful drug to give. It's once or twice a day SQ and your done. NO more sticking your Pt's. constantly for levels so you can continually spend your day adjusting the heparin. Teach an old dog new trick and tell the Dr. LOVENOX is better on everybody and the pt can go home on it too. If a diabetic can give himself SQ's so can a stroke/DVT pt.