Dual Antiplatelet Therapy for Small Acute Ischemic Strokes (NINDS Score ≤ 5 and TIA)

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The impact of the ever-changing COVID-19 pandemic is creating a rapidly evolving clinical environment for healthcare providers (HCPs). HCPs are challenged to keep up with the most current clinical information, while constantly evolving their approaches to the management of patients with acute ischemic stroke or transient ischemic attacks (TIA).  As a result, innovative approaches are required to educate HCPs on how they can make a positive impact on patient care and improve clinical outcomes in the new COVID-19 world, especially as it relates to emergency medicine. 

Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes. About 185,000 strokes—nearly 1 of 4—are in people who have had a previous stroke. About 87% of all strokes are ischemic strokes, in which blood flow to the brain is blocked. The economic costs of stroke are staggering, as it results in an estimated $34 billion in healthcare expenditures each year, which includes the cost of health care services, medicines to treat stroke, and missed days of work. Of particular concern, the risk of recurrent stroke is highest during the first 90 days after an index stroke; longitudinal studies indicate that approximately 1 out of every 2 recurrences occurring in the first year occurs within the first 90 days. Of the three major stroke types, TIA is different from both of the more common ischemic and hemorrhagic strokes, in that blood flow to the brain is blocked only for a short period of time. More than a third of people who have a TIA and don’t get treatment have a major stroke within 1 year. As many as 10% to 15% of people will have a major stroke within 3 months of a TIA, particularly an ischemic stroke. Current international guidelines recommend antiplatelet therapy for secondary prevention in patients with acute stroke or TIA of non-cardioembolic origin, as aspirin is the only antiplatelet agent that has received a class 1A recommendation.

For the long-term secondary prevention of stroke in patients with a history of non-cardioembolic ischemic stroke or TIA, recommendations have been published as far as using an antiplatelet agent using either aspirin, clopidogrel, or aspirin-extended-release dipyridamole. New data has become available to test the theory that perhaps there is another agent that should be part of that consideration set. With the advent of new data, clinicians need to become well versed in evolving their practice patterns to improve the standard of care when managing patients and utilizing antiplatelet therapy for the secondary prevention of ischemic stroke.

This program covers strategies to prevent secondary stroke in patients who had an acute ischemic stroke or transient ischemic attack; as well as analyzes results of recent clinical trial data and application of agents used to manage small acute ischemic stroke.   

  • What Is the Pathophysiology of Subsequent Stroke in Patients With Acute Noncardioembolic Cerebral Ischemia?

  • What Are the Key Risk Factors and Clinical Manifestations of Transient Ischemic Attack and the Impact of a Cardiac Origin to These Events?

  • How Do Clinicians Translate the Meaning of NINDS Scoring for Small Ischemic Strokes?

  • Effectiveness of P2Y12 Inhibitors in Stroke Prevention

  • Case Study: A 57-Year-old Male with an Acute Stroke, NIHSS 4

  • What Are the Limitations & Key Considerations With Current Modalities To Prevent Secondary Ischemic Events in Acute Non-Cardioembolic Cerebral Ischemia Patients?

  • What Is the Best Approach to Prevent Secondary Events in Small Acute Strokes (NINDS Score of 5 or Less) and TIA?

  • What Is the Pathophysiology of Subsequent Stroke in Patients With Acute Noncardioembolic Cerebral Ischemia?

Faculty:

W. Brian Gibler, MD FACEP, FACC, FAHA
President, EMCREG-International
Professor of Emergency Medicine
University of Cincinnati College of Medicine
Cincinnati, OH

Deepak L. Bhatt, MD, MPH
Executive Director of Interventional Cardiovascular Programs
Brigham and Women’s Hospital Heart and Vascular Center
Professor of Medicine, Harvard Medical School
Boston, MA

Galen V. Henderson, MD
Director, Neurocritical Care and Neuroscience Intensive Care Unit
Assistant Professor, Harvard Medical School Division of Neurocritical Care
and Stroke Department of Neurology
Brigham and Women’s Hospital
Boston, MA

Natalie Kreitzer, MD, MS
Assistant Professor
Emergency Medicine and Neurocritical Care
University of Cincinnati, Cincinnati, OH

Jordan Bonomo, MD, FCCM, FNCS
Associate Professor of Emergency Medicine
NeuroCritical Care / Neurosurgery
University of Cincinnati
Cincinnati, OH