150 likes | 282 Vues
The ABCs of Secondary Stroke Prevention. Chris Shaffer, FNP MMP Neurology/MMC Inpatient Neurology Consult Service Maine Nurse Practitioner Association Annual Conference May 1, 2014. Welcome to the MNPA 2014 Conference. It is a distinct honor to present to you, my esteemed peers!.
E N D
The ABCs of Secondary Stroke Prevention Chris Shaffer, FNP MMP Neurology/MMC Inpatient Neurology Consult Service Maine Nurse Practitioner Association Annual Conference May 1, 2014
Welcome to the MNPA 2014 Conference • It is a distinct honor to present to you, my esteemed peers!
Disclosures • I am employed by Maine Medical Partners Neurology and Maine Medical Center, Dept. of Medicine • I have no financial interest in any of the information presented today
Objectives • Participants will understand: • 1. Indications for Antiplatelet therapy and Anticoagulation Post- Ischemic- Stroke • 2.Blood pressure goals post-stroke • 3. Diabetes management goals post-stroke • 4. Cholesterol goals post-stroke • 5. Brief overview of new anticoagulation agents in addition to warfarin (pharmacology update)
Antiplatelet Therapy • Is Aspirin really enough? 81 vs 325 mg vs more? Does ASA fail?
Anticoagulation • Indications: • Atrial Fibrillation- the elusive arrhythmia • PFO- what to do? ASA? Atrial septal aneurysm? Age? • Recommend reversal after ICH, SAH, SDH, Consider resuming after 1-2 weeks
Atrial Fibrillation: • Atrial Fibrillation • 2.7 Million Americans have Afib! • Afib is associated with a 5-fold increase in stroke risk • 15% of all strokes are from Afib.
Hypertension • Hypertension: • 72 Million Americans (2011) have HTN: >140/90 • ACEI/ARB + thiazide diuretic most protective against stroke • What SHOULD the ideal BP be in your post-stroke patient?
Diabetes: • Diabetes: • 25.8 Americans have Diabetes. • What should the HbA1C be for post-stroke patients?
Womens’ Issues: • It’s a girl thing: • 9 Million women die each year from heart disease worldwide • Pregnancy and cancer are pro-thrombotic states and we often overlook s/sx TIA and stroke in those populations
Drugs, Fats, and Alcohol: • Hyperlipidemia: • LDL should be <100, ideally <70 (if CHD, severe stenosis, DM) • Obesity: BMI>30 increases stroke risk (duh) • Quit tobacco and secondary exposure • ETOH- the J curve
Monday Morning Call • You are notified that a patient of yours is being discharged form the hospital after having an ischemic stroke. • When should you schedule this follow-up appointment? • What will you address at this visit?
What Lab Tests Are Important? • Bmp vscmp • FLP • HbA1C • When? Why? How often?
Clinical Resources • AHA/ASA Get With The Guidelines • http://stroke.ahajournals.org: Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline For Healthcare Professionals from the American Heart Association/American Stroke Association Dr. Jane Morris and Dr. John Belden, stroke experts, MMP Neurology: 207-883-1414 My expert Nurse Practitioner Colleagues at MMP Neurology: Georgeann Dickey Jason Aucoin Diana Page
The End • Thank You and Enjoy the Conference! • Chris Shaffer, FNP-BC, MS-N • Maine Medical Partners Neurology • Email: shaffc1@mmc.org