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ECV ISQUEMICO

1. Declinig Morbidity and Mortality Rates


Although the morbidity and mortality associated with stroke are high,
the rates have been declining. From 2001 to 2011, the stroke mortality
rate declined by 35%

2. Enfoque por horas

3. Diagnostico diferencial

Stroke March 2013

4. Criterios de inclusin
a. Criterios mayores

b. Criterios menores

DECEMBER 2015 . VOLUME 82 SUPPLEMENT 2


CLEVELAND CLINIC JOURNAL OF MEDICINE

5. Escala de NIHSS

Use of a standardized assessment and stroke scale helps quantify


the degree of neu- rological deficits, facilitate communication,
identify the loca- tion of vessel occlusion, provide early prognosis,
help select patients for various interventions, and identify the
potential for complications.

6. Terapia fibrinolitica
Also well documented is the significant impact of time- to-tPA treatment
on outcomes. If therapy is started within 3 to 4.5 hours of ischemic
stroke onset, patients have improved functional outcomes 3 to 6 months
after the incident . Between 31% and 50% of patients treated with tPA
within 3 hours experienced improved recovery at 3 months compared
with 20% to 38% of patients treated with placebo.

The label also identifies advanced age as a warning, stating that for
patients >75 years of age, the risks of alteplase therapy may be
increased and should be weighed against the anticipated benefits.

Scientific Rationale for the Inclusion and Exclusion Criteria


for Intravenous Alteplase in Acute Ischemic Stroke. Stroke February 2016

7.1. Recomendaciones en el manejo de la TA en la terapia


fibrinolitica

7.2 Esquema de manejo

8. Interacciones de nuevos anticoagulantes

9. Anticoagulacion en condiciones especiales

10. Recomendaciones antitromboticas en FA

Selecting antithrombotic therapy for patients with atrial fibrillation


Cleveland Clinic Journal of Medicina VOLUME 82 NUMBER 1 JANUARY 2015

11. Comparativo de anticoagulantes

CONTRAINDICACIONES
Absolutas: se consideran contraindicaciones absolutas aquellas en la cuales no
se debe anticoagular por el grave riesgo hemorrgico existente:
1. Ditesis hemorrgicas congnitas o adquiridas.
2. Procesos hemorrgicos (ulcus gastroduodenal sangrante, neoplasia ulcerada,
etc.).
3. Hipertensin arterial severa no controlable.
4. Retinopata hemorrgica.
5. Aneurisma intracerebral.
6. Hemorragia intracraneal.
7. Hepatopatas y nefropatas graves.

Relativas: aquellas situaciones en las cuales la anticoagulacin va a depender,


en cada paciente, de la balanza entre el riesgo tromboemblico y riesgo
hemorrgico. En caso de decidirse por la anticoagulacin, se debe controlar a
estos enfermos de forma ms estricta.
1. Hepatopata crnica.
2. Ulcus gastroduodenal activo.
3. Hernia de hiato.
4. Esteatorrea.
5. Alcoholismo.
6. Gestacin.
7. Edad avanzada.
8. Escaso nivel mental.
9. Pericarditis con derrame.
10. Alteraciones mentales, especialmente con tendencia al suicidio.
INTERACCION CON ANTICOAGULANTES
Potencian:
Interaccin altamente probable
Eritromicina
Fluconazol
Isoniazida
Miconazol
Cotrimoxazol
Amiodarona
Clofibrato brato
Interaccin probable
Ciprofloxacino
Itraconazol
Tetraciclinas
Aspirina
Quinidina
Simvastatina
Acetaminofeno
Propafenona
Propranolol
S
ulfinpirazona
Fenilbutazona
Piroxicam Alcohol (con enfermedad
heptica) Cimetidina Omeprazol
Dextopropoxifeno
Hidrato de cloral
Disulfiram
Fenitona

Esteroides anablicos
Fluvacina
Tamoxifeno
Existen otros frmacos que en
determinados pacientes pueden
producir interacciones.
Inhiben:
Interaccin altamente probable
Griseofulvina Rifampicina Nafcilina
Colestiramina
Barbitricos
Carbamazepina
Clordiazepxido
Sucralfato
Alimentos
con
alto
contenido
en
vitamina
K
Alimentacin enteral Gran cantidad
de aguacate
Interaccin probable
Dicloxacilina
Coles de Bruselas