Welcome to Part 2 of Episode 17 on Stroke with Dr. Dan Seltran and Dr. Walter Himmel. In this part of the episode, we're going to talk about anti-platelet choices for stroke, when to use heparin in the setting of stroke, and the challenging diagnosis of posterior circulation stroke and its unique management. We'll then present a case of embollic stroke and discuss the pros and cons of the newish medication, Dabagatran,

and what to do in the case of a Dabagatran overdose bleed. And then we'll talk about the

newest in management of ICH, including when it's ICH associated with warfarin or an anti-platelet

agent. Okay, so we've talked about all the basic supportive management.

Let's talk a little bit about anti-platelet agents.

In the TIA discussion that we had last year, we agreed that for TIA, a dose of 160 to

325 milligrams of ASA to chew should be given as soon as the CT confirms no bleed.

And for patients with a true allergy to ASA or who have failed ASA,

there's the option of giving clopidigril,

a loading dose of 300 milligrams, followed by 75 milligrams daily,

or an initial dose of 75 milligrams with continued overlap use of ASA for three or four

days. And the other option would be to switch to Agrinox BID, which has the disadvantage of commonly

causing headache. Patients receiving TPA should not get any anti-plated agents in the first 24 hours.

We know that.

But what about the patients who do not receive Lytics?

Are the anti-platlet considerations for stroke the same as they are for TIA?

Is there anything different than what we discussed for TIA?

Basically, it's really the same paradigm.

There really wouldn't be very much difference in a stroke

with fluctuating and evolving symptoms.

I would probably load them with clopidigril immediately.

And if they were already on ASA, maintain the ASA,

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