Question

A 62-year-old man suddenly experienced difficulty speaking and left-sided weakness. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. Which best describes the guidelines for antiplatelet and fibrinolytic therapy?

A. Give heparin if the the CT scan is negative for hemorrhage
B. Hold aspirin for at least 24 hours if rtPA is administered
C. Give aspirin 120 mg and clopidogrel 75 mg orally
D. Give aspirin 162 to 325 mg to be chewed immediately

Answer 1

The best guideline is to hold aspirin for at least 24 hours if rtPA is administered (option B) , as this thrombolytic agent helps restore blood flow by dissolving clots in the case of an ischemic stroke and is given within a critical 3-hour window. A CT scan is done first to exclude hemorrhagic stroke.

Step-by-step explanation:

The correct guideline for antiplatelet and fibrinolytic therapy, in a case where a 62-year-old man is showing symptoms of an acute ischemic stroke, is to hold aspirin for at least 24 hours if rtPA (recombinant tissue plasminogen activator) is administered. rtPA is a type of thrombolytic agent and is the treatment of choice for an ischemic stroke if administered within a crucial 3-hour window from the onset of symptoms. This therapy aims to dissolve the occluding blood clot and restore normal blood flow to prevent permanent brain damage.

A computer tomography (CT) brain scan is mandatory before administering rtPA to exclude a hemorrhagic stroke, for which rtPA would be contraindicated. Heparin may be considered following fibrinolytic therapy, but it's not immediately administered. As for antiplatelet therapy, it is recommended to delay the initiation of aspirin or other antiplatelets such as clopidogrel following the administration of rtPA due to the increased risk of bleeding.