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June 21, 2019

As we move up, so then if we’re looking at other types of strokes beyond a fib and carotid stenosis, generally the approach is a multi sort of pronged approach. One, it’s some type of blood thinner. The mainstay, the one that we use the longest is aspirin. Often a question that’s asked is, well what’s the right dose of Aspirin? We don’t know. Somewhere between 81 and 325 and it sort of depends on the case. I would point out in someone using an 81 milligram aspirin, I would advise not using an enteric coated, not using an enteric coated aspirin as it may be less bioavailable. But between 81 and 325, any dose probably works and it sort of depends on the patient and something to talk to your doctor about. There are other types of blood thinners and someone who comes in and it was on aspirin already, we’ll consider other types of blood thinners that may be more effective than aspirin. One’s called clopidigrel or Plavix is the brand name, but it’s available as a generic and another one that’s extended release diaprimonal and aspirin together and that’s got a brand name called agronox. Both of those drugs can be more effective than aspirin at preventing stroke in the right patient. The next thing we want to pay attention to is the cholesterol. And again, I emphasize there is lots of data now that’s out that shows that statins help prevent recurrent strokes and we pay very close attention to what the total cholesterol is and also what that LDL, the bad cholesterol is. And we want that LDL low. Less than a hundred and in some cases less than 70. Next we wouldn’t pay careful attention to the blood pressure. And from my perspective, blood pressure control in the first few days after a stroke is not crucial. We actually let the blood pressure go up a little bit in the first few days with the idea being there’s a clot up there and the body knows how to get blood around that clot and it does it by elevated blood pressure. But over the long term, months for sure, we want that blood pressure well controlled. And that’s often a combination of diet, watching your sodium intake, exercise, and medications. Again, I point out that the disturbing sort of a statistic from the American Heart Association that with high blood pressure, 50% of patients aren’t well controlled and is the major risk factor for stroke in a crucial one for us to control well.

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