recombinant tissue plasminogen activator (rt - PA) causes fibrinolysis by binding to fibrin in a thrombus (clot) and converts entrapped plasminogen to plasmin

CI: bleeding

SE: major bleeding (e.g. ICH)

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used to decrease BP and possibly qualify patients for rt-PA; decrease BP gradually

(a) SAH is associated with a high incidence of delayed cerebral ischemia 2 weeks following the stroke

(b) Vasospasm is thought to be the cause of the delayed ischemia and occurs 4 - 21 days after the bleed

(c) Nimodipine (Nimotop) 60 mg PO Q4h should be initiated and continued for 21 days

(d) Watch BP

Control blood pressure and lipids

Ensure optimal blood glucose control in diabetes

Use anticoagulants for A-fib

Encourage life changes: stop smoking, increase physical exercise, improve diet, encourage weight reduction (BMI < 25) and limit alcohol intake (LOL, yea right!)

Previous TIA or stroke; non-cardioembolic. If previous cardioembolic stroke, use warfarin.

Aspirin

Clopidogrel

Dipryidamole ER/ Aspirin

Drug interactions of note (I got lazy):

(a) avoid use, if possible, with other agents that increase bleeding risk, including other antiplatelets (although clopidogrel is generally used with low - dose aspirin), NSAIDs, anticoagulants, ginko, etc.

(b) Clopidogrel is a prodrug metabolized by CYP 2C19. Avoid concomitant use with strong or moderate 2C19 inhibitors (omeprazole, esomeprazole, cimetidine, fluconazole, ketoconazole, voriconazole, fluoxetine, fluvoxamine)