Clinical Cases in Secondary Stroke Prevention - CSHP Ontario Branch 71st Annual Conference

Sep 24, 2026

Uploaded by dhado

Clinical cases presentation for secondary ischemic stroke prevention from the CSHP Ontario Branch 71st Annual Conference (Nov 16, 2019). The talk reviews ischemic stroke risk factors, etiologies, diagnostic workup, and key trial outcomes, then focuses on applying evidence to choose appropriate prevention strategies across antithrombotic therapy, lipid-lowering, and hypertension management. Case-based decision making is demonstrated with a patient presenting MRI-confirmed lacunar infarction and detailed laboratory, ECG, and imaging findings.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages82

Reading Time3 h 27 min

AccessFree to download

Learning Objectives

Background

Secondary Stroke Prevention

Case 1: Harry (54-year-old male)

Polling Question: Most Appropriate Antithrombotic Therapy

Step One: Determine Etiology

Clinical Cases in Secondary Stroke Prevention CSHP Ontario Branch 71 st Annual Conference November 16, 2019 Jacqui Herbert, BScPhm, ACPR Clinical Pharmacist – Stroke Rehabilitation Toronto Rehabilitation Institute, UHN Disclosures I have no financial disclosures or conflicts of interest to report I have no current or past relationships with commercial entities This program has received no financial or in-kind support from any commercial or other organization Learning Objectives 1. In the context of clinical cases: a. Review ischemic stroke risk factors, etiologies, and workup b. Review major trial outcomes in stroke c. Determine appropriate secondary ischemic stroke prevention including considerations for antithrombotic therapy, lipid-lowering therapy, and hypertension management 2. Apply the above knowledge to patient cases to make appropriate clinical decisions Background Stroke: term used to describe an abrupt-onset focal neurological deficit that lasts at least 24 hours and is of presumed vascular origin 1 􀂾 Location of the injury determined through imaging studies of the brain (i. e. CT, MRI) 􀂾 NIH Stroke Scale (NIHSS) can help quantify impairment from stroke (0-42) Stroke survivors are at high risk of recurrent stroke, often more severe and disabling than index event 2 Optimal secondary prevention of stroke requires rapid diagnosis and treatment including prompt identification of the underlying cardiovascular cause 2 Focus of today’s workshop will be cases of ischemic stroke prevention beyond the acute phase 1. Fagan S, Hess D. Stroke. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York, NY: McGraw-Hill; 2014: 354. 2. Hankey, G. Secondary stroke prevention. Lancet Neurol 2014; 13: 178–94. Secondary Stroke Prevention | | | | | | | | --- | --- | --- | --- | --- | --- | | | | Antithrombotic therapy
• Antiplatelet therapy
• Anticoagulant therapy |
| | Lipid management | | | | | | | | | | | | | | | | | | | | | | | | | Hypertension management
• Acute phase
• Long-term | | | Diabetes management | | | | | | | | Case 1: Harry is a 54 year old male patient in ER. droop (last seen well last night at 22:00) . infarct. He woke up with new left arm weakness and left facial CT head was initially negative; MRI confirmed R lacunar Past Medical History: • None known, no GP Current Medications: • None Social History: • Drinks approximately 20-25 alcoholic drinks per week • Smokes 1 ppd x 30 years What medications should be started for appropriate secondary stroke prevention? Case 1: Harry is a 54 year old male patient in ER. droop (last seen well last night at 22:00) . infarct. He woke up with new left arm weakness and left facial CT head was initially negative; MRI confirmed R lacunar Past Medical History: • None known, no GP Current Medications: • None Social History: • Drinks approximately 20-25 alcoholic drinks per week • Smokes 1 ppd x 30 years Relevant Findings & Laboratory Results: • BP 187/95, HR 77 • Weight 88 kg • HbA1C 6.0% NIHSS = 3 • LDL 3.2 mmol/L • Hgb 152 g/dL • SCr 90 umol/L • ECG: Normal Sinus Rhythm • 48-hour Holter pending, no AF on tele • TTE: Normal LV/RV size and function, no obvious thrombus, no significant valvular pathology • CTA head/neck: Diffuse atherosclerosis without significant stenosis What medications should be started for appropriate secondary stroke prevention? Polling question: most appropriate antithrombotic therapy for Harry right now? A. Acetylsalicylic acid (ASA) B. Clopidogrel C. ASA and Dipyridamole D. A, B, or C E. DAPT – ASA + Clopidogrel x 21-30 days, then SAPT with either agent F. DAPT – ASA + Clopidogrel x 90 days, then SAPT with either agent G. Oral anticoagulation Step one: Determine etiology

FAQs

What are the learning objectives for secondary ischemic stroke prevention in the clinical cases workshop?

Participants review ischemic stroke risk factors, etiologies, workup, and major trial outcomes, then apply this knowledge to patient cases to select appropriate secondary prevention. Focus includes antithrombotic therapy, lipid-lowering therapy, and hypertension management considerations.

How does the presentation frame the background and diagnostic approach to stroke?

Stroke is defined as an abrupt-onset focal neurological deficit lasting at least 24 hours with presumed vascular origin. The program emphasizes imaging to locate injury, use of NIHSS to quantify impairment, and the importance of rapid diagnosis and identification of the underlying cardiovascular cause.

What decision point is highlighted for Case 1 (Harry) regarding treatment?

The presentation asks which antithrombotic therapy should be started for appropriate secondary stroke prevention right now. A polling question lists options including single antiplatelet therapy, combination therapy durations (DAPT), or oral anticoagulation, followed by Step one: determine etiology.

Sep 24, 2026

Uploaded by dhado