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

Answer 1

The administration of fibrinolytic therapy, such as rtPA, is recommended within 3 hours of a thrombotic stroke to improve outcomes but requires holding aspirin for at least 24 hours due to bleeding risk.

Step-by-step explanation:

When a 62-year-old man experiences difficulty speaking and left-sided weakness, this may indicate a thrombotic stroke, and guidelines for fibrinolytic therapy such as recombinant tissue plasminogen activator (rtPA) are often considered for treatment.

This therapy is crucial because it involves the administration of thrombolytic agents that can significantly improve a patient's prognosis if administered within a 3-hour window from the onset of the stroke. However, before initiating this treatment, a CT scan or similar diagnostic test is essential to exclude a hemorrhagic cause for the stroke. If rtPA is administered, it is recommended to hold aspirin for at least 24 hours since aspirin has antiplatelet properties that might increase the risk of bleeding when combined with thrombolytic therapy. The aim of fibrinolytic therapy is to facilitate clot degradation and restore normal blood flow, helping to prevent permanent brain damage from ischemia.