Part 2: Ischemic Stroke: Evaluation, Treatment, and Prevention

Matthew Brandon Maas, MD, and Joseph E. Safdieh, MD

Dr. Maas is a fellow in Stroke and Neurocritical Care, Harvard Medical School, Departments of Neurology, Massachusetts General and Brigham and Women’s Hospitals, Boston, MA. Dr. Safdieh is an assistant professor of neurology, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY.

Question 6

Due to thrombocytopenia, the patient does not receive intravenous tPA. Because no large proximal vessel occlusions are identified on CT angiography, revascularization interventions are not pursued. MRI is performed, which shows a DWI hyperintense lesion of relatively small volume in the posterior limb of the internal capsule and posterior corona radiata. The patient is admitted for further evaluation and management. The ECG abnormalities are pursued by drawing a repeat panel of cardiac enzymes, which are reported as elevated. The patient is seen by a cardiologist, who emphasizes the need for antithrombotic therapy.
Which of the following statements regarding heparin therapy is most accurate?

  •  Administration of heparin in the acute phase is likely to prevent deterioration of
    the patient’s neurologic condition
  •  Administration of heparin is contraindicated in the acute phase due to an
    unacceptable risk for hemorrhagic conversion
  •  Administration of heparin is unlikely to benefit the patient’s neurologic condition
    but is reasonable in the context of an acute myocardial infarction
  •  Administration of heparin must be delayed for 24 hours to mitigate the risk of
    hemorrhagic complications

Updated 12/03/2014 • jdw | Copyright ©2014 Turner White Communications