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!
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.
Speculating, the CT of the head was negative, so it was NOT a hemhorragic stroke. As was said above, the angoicath procedure was probably the reason they chose not to use any anticoagulants stronger than ASA.
Speculating, the CT of the head was negative, so it was NOT a hemhorragic stroke. As was said above, the angoicath procedure was probably the reason they chose not to use any anticoagulants stronger than ASA.
I'm so sorry for you and your husband, and playing Monday morning quarterback can do more harm sometimes than good. Being a nurse you know you have a good year for progress to be seen. The time frame is generally a big issue for TPA or Streptokinase. I believe its 4-6 hours still, and they're very precise about the time frame. When we know it's a stroke we're dealing with we always keep sticks to a minimum. We still draw blood, IV's, and ABG's so I can't imagine the arterial stick being a great issue especially since they knew exactly were it was, but the angiocath could very well have been there reasoning. The time frame could have been a problem too. If I were having a stroke and being an ER nurse, and it had been 24 hours since onset of symptoms. I'd have my hands around the ER doc's throat saying time frame - frime frame push the TPA NOW! I'm not a religious person however keep the faith, and my prayers are with you Jane.
As far as long term issues go, definately need to be thinking about an ARB. Personally, I like Atacand.
Would need to know a little more, but from what I'm getting so far PLAVIX PLAVIX PLAVIX
Dave
Certainly, Plavix and ASA are a great combination post stroke treatment, but like heparin and Coumadin they only help with anticoagulation (the prevention of formation of further clots). They don't help with the actual clot that caused the stroke in the first place, but without hesitation they absolutely should become a prophylactic part of ongoing treatment in this case.
Thank you all for the condolences, but my point was to let Jay-Jay know that it isn't always as bad as it could be. My dad is doing great-all things considered.
Jay-Jay, there is always hope. Being a nurse makes it so much more difficult as we sometimes know too much. Take care of yourself too- the stress is profound. Also-as you already know- you have tons of support here......
What about the A-fib. Shouldn't he go back on coumadin for that?
I must have missed something. I didn't realize a-fib was involved which could have been a great instigator in the stroke. What a bad nurse I am for missing that. I'm still a Lovenox man myself. It's cheaper, easier, and no need for all the blood work, and the $$$ from the biweekly to monthly MD visits to keep levels in check.
Specializes in CCU (Coronary Care); Clinical Research.
We give tpa a fair ammount where I work, however, as others have mentioned, there are quite a few criteria that must be met...the doctor has to weigh the risks vs. benefits. tpa must be given within three hours from the onset of symptoms....that means if a person wakes up in the am with one side down and he/she went to bed at 10:00 at night, they don't qualify becuase the onset is unknown. As mentioned a hemmoragic stroke must be ruled out by CT...no surgeries or other trauma within a certain time frame pre-stroke, there are age limits as well (can't remember what though). The list is longer but I can't remember the whole check-list. The criteria that gets most people is the 3 hour window. In various trials it was shown to be not as effective past that time frame. Strokes are difficult because there really isn't a lot that can be done at the time (unlike, say, a PCI for an acute heart attack). If you look up tissue plasminogen activator in google, there are lots of sites that pop up with information about stroke and tpa. There are also various clinical trials taking place for new stroke medications but, of course, the critieria for these is rather stringent as well. As a mentioned before, jenac and jay-jay...I hope your loved ones are recovering well.
In this case, Coumadin has to be restarted because of the a-fib. However, I would not normally use Coumadin just because of a-fib.
Some of the newer stuff I've read states that ASA is enough to eliminate the risk of clot formation r/t Atrial fib. IN a health patient with no other on going health issues. Given JayJay's husbands history of the angio, and now having a stroke... he's going to be blown right out of the group that ASA is enough for.
Possibly, Lovenex SQ could also be used here. Just depends on what his labs looks like.
I must have missed something. I didn't realize a-fib was involved which could have been a great instigator in the stroke. What a bad nurse I am for missing that. I'm still a Lovenox man myself. It's cheaper, easier, and no need for all the blood work, and the $$$ from the biweekly to monthly MD visits to keep levels in check.
Why can't by now they come up with a Lovenox pill????
I think she mentioned in the Breakroom he had to go off his coumadin for his a-fib for the angio, and then threw a clot most likely from the a-fib and not being on coumadin. That's probably why you didn't know, sorry.
Specializes in RETIRED Cath Lab/Cardiology/Radiology.
Just a question: why didn't they put him on Lovenox while off the coumadin? He had to be off the coumadin at least 3 days pre-angio . . . not trying to stir up anything, it's an honest question.
Speculating
343 Posts
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.