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Stroke therapy

Stroke therapy. Aspirin MOA : antiplatelet agent (COX inhibitor -> irreversible platelet inactivation) Recurrent stroke prevention, also Rx acute stroke PK : mixed order clearance, 81mg or 325mg qd

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Stroke therapy

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  1. Stroke therapy

  2. Aspirin MOA: antiplatelet agent (COX inhibitor -> irreversible platelet inactivation) Recurrent stroke prevention, also Rx acute stroke PK: mixed order clearance, 81mg or 325mg qd Toxicity: GI (eg gastritis), bleeding, renal (afferent arteriole constriction -> decrease GFR)

  3. Ticlopidine MOA: antiplatelet agent (irreversible inhibition of ADP-induced platelet aggregation) Declining use but may be slightly better than aspirin Toxicity: diarrhea, leukopenia(CBC after 3 months).

  4. Clopidogrel (plavix TM) MOA: antiplatelet agent (irreversible inhibition of ADP-induced platelet aggregation) Slightly better than aspirin for secondary stroke prevention Toxicity: fewer than ticlopidine (no leukopenia), rare TTP

  5. Dipyridamole MOA: antiplatelet agent (PDE inhibitor -> decrease aggregation) Ineffective alone (use with aspirin or warfarin) Aggrenox: sustained release dipyridamole + aspirin to Rx secondary stroke prevention

  6. Abciximab(ReoPro TM) MOA: antiplatelet agent (mAbFab fragment against platelet glycoprotein IIb-IIIa) Rx unstable angina, off-label Rx stroke (under evaluation).

  7. Heparin MOA: anti-coagulant (glycosaminoglycan mixture activating antithrombin III) Clot formation prevention (e.g Rx crescendo TIA) No role in acute stroke Rx (NOT thrombolytic) PK: IV or SQ only Toxicity: hemorrhage (follow w/ PTT), antidote protamine.

  8. Low MW Heparinoids (lovenox TM or fragmin TM) MOA: anti-coagulant (low MW fraction of heparin) PK: fixed dose Blood test: consider factor Xa

  9. Warfarin (coumadin TM) MOA: anti-coagulant (blocks vitamin K dependent clotting factors) Slow onset (use heparin to tie over) PK: oral, high protein bound -> many drug interactions Toxicity: close monitoring (PT or INR), antidote fresh frozen plasma.

  10. tPA (activase TM or alteplaseTM) MOA: thrombolytic (human enzyme cleaves plasminogen into plasmin) Rx stroke w/in 3 hr of onset PK: IV or IA Toxicity: MANY contraindications -> use with caution.

  11. Urokinase MOA: thrombolytic (human enzyme cleaves plasminogen to plasmin). Not in use anymore.

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