For patients hospitalized with stroke, should we be prescribing high dose statins at discharge, in an attempt to reduce their risk of recurrent stroke? As we recall the results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial (4731 patients with prior stroke or TIA with no known CAD, randomized to atorvastatin 80 or placebo) (abstract), statin patients had a 16% lower risk of overall stroke, but a significantly higher risk of non-fatal hemorrhagic stroke (55 vs 33 patients). To help further understand those 88 hemorrhagic stroke patients, researchers performed a post hoc analysis to define their risk for hemorrhage. They found prior hemorrhagic stroke, male sex, older age, and stage 2 (JNC 7) hypertension were associated with hemorrhagic stroke (abstract). Editorialists surmise that, for patients without these risk factors, the benefits of statins for secondary stroke prevention clearly outweigh the risks. For those with prior hemorrhagic stroke or older hypertensive men, the risks and benefits are less clear, and need to be very carefully weighed (editorial)
In this large multicenter trial, patients with minor stroke or TIA were randomized to clopidogrel+ASA or ASA alone; 90-day stroke occurred in 8% vs 12% respectively, and rates of hemorrhage or hemorrhagic stroke were the same (abstract).
These guidelines provide an evidence based for the use of periprocedural antithrombotics in patients with cerebrovascular disease. They recommend continuing ASA-warfarin for dental procedures, and most other minor procedures. There is little evidence to support the use of procedural bridging with heparin, and it does increase the risk of bleeding. Cessation of therapy for 7 […]
A large analysis from a stroke registry found better outcomes with earlier thrombolytics for acute ischemic stroke; every 15 minutes earlier was associated with an odds ratio of 0.96 for in-hospital death or intracranial hemorrhage, and an odds ratio of 1.03 for being discharged home and 1.04 for walking independently at discharge (abstract).