Cea Case Studies

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CEA surgery is indicated if CVA occurred within the past 6 months in patients with documented ipsilateral carotid artery stenosis (70%–99%).
Depending on age, gender and other comorbidities CEA is indicated in patients with recent CVA and documented moderate same sided carotid stenosis (50%– 69%)
The estimated perioperative morbidity and mortality risk must be <50%.
Include antiplatelet and statin in managing patients with carotid artery stenosis and stroke.
For patients with stroke secondary to 50% - 99% occlusion of a major intracranial artery, aspirin 325 mg/d is preferred to warfarin.
Clopidogrel + Aspirin 325 x 90 days may be used in patients with recent stroke or within the last 30 days caused by 70% - 90% stenosis of a major intracranial artery.
Do not
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There is no need for INR monitoring.
Combination Anticoagulation and Antiplatelet Therapy
There is no evidence to support combination use has any advantage reducing risk of stroke or MI when compared with anticoagulant therapy alone.
Increased risk of bleeding.
Warfarin, dabigatran, and apixaban are all indicated for the prevention of recurrent stroke in patients with nonvalvular AFIB, paroxysmal or permanent.
Choose drug based on risk factors, patient preference cost, the potential for drug interactions, tolerability, renal function. Rivaroxaban is acceptable for the prevention of stroke reoccurrence in patients with nonvalvular AFIB.
Use anticoagulant /antiplatelet combination only in patients with clinically apparent CAD, especially an ACS or stent placement.
Give aspirin to patients who are unable to use oral anticoagulants.
Addition of clopidogrel to aspirin therapy might be reasonable compared with aspirin therapy alone.
It is reasonable to initiate anticoagulation within 14 days after onset of stroke in most

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