Stroke therapy
	See also Sec 1/Rev xx - Integrated Platelets, Hemostasis, and Thrombosis

Aspirin
	
	MOA: antiplatelet agent (COX inhibitor -> irreversible platelet inactivation)
	Recurrent stroke prevention, also Rx acute stroke
	PK: mixed order clearance, 81mg or 325mg qd
	Tox: GI (eg gastritis), bleeding, renal (aff arteriole constr -> dec GFR)

Ticlopidine
	
	MOA: antiplatelet agent (irrev inhibition of ADP-induced platelet aggregation)
	Declining use but may be slightly better than aspirin
	Tox: diarrhea, leukopenia* (CBC after 3 mo)

Clopidogrel (plavix TM)
	
	MOA: antiplatelet agent (irrev inhibition of ADP-induced platelet aggregation)
	Slightly better than aspirin for secondary stroke prevention
	Tox: fewer than ticlopidine (no leukopenia), rare TTP*

Dipyridamole
	
	MOA: antiplatelet agent (PDE inhibitor -> dec aggregation)
	Ineffective alone (use with aspirin or warfarin)
	Aggrenox: sustained release dipyridamole + aspirin to Rx secondary stroke prevention

Abciximab (ReoPro TM)
	
	MOA: antiplatelet agent (mAb Fab fragment against platelet glycoprotein IIb-IIIa)
	Rx unstable angina, off-label Rx stroke (under evaluation)

Heparin
	
	MOA: anti-coagulant (glycosaminoglycan mixture activating antithrombin III)
	Clot formation prevention (eg	Rx crescendo TIA)
	No role in acute stroke Rx (NOT thrombolytic)
	PK: IV or SQ only
	Tox: hemorrhage (follow w/ PTT), antidote protamine

Low MW Heparinoids (lovenox TM or fragmin TM)
	
	MOA: anti-coagulant (low MW fraction of heparin)
	PK: fixed dose
	Blood test: consider factor Xa

Warfarin (coumadin TM)
	
	MOA: anti-coagulant (blocks vitamin K dependent clotting factors)
	Slow onset (use heparin to tie over)
	PK: oral, high protein bound -> many drug interactions
	Tox: close monitoring (PT or INR), antidote fresh frozen plasma

tPA (activase TM or alteplase TM)
	
	MOA: thrombolytic (human enzyme cleaves plasminogen into plasmin)
	Rx stroke w/in 3 hr of onset
	PK: IV or IA
	Tox: MANY contraindications -> use w/ caution

Urokinase
	
	MOA: thrombolytic (human enzyme cleaves plasminogen to plasmin)
	Not in use anymore