My CVA pt Took Aspirin

[IsraelEMS]

My CVA pt took aspirin for his headache. Then he called us and said that the headache was worse now and that he could no longer use his right arm or leg. The thing is the guy had a history of previous TIAs. Why did he even have aspirin in the house? Thank G-d he was still alive by the time we got him to the hospital but in the VERY short transport time it was headed into catastrophe.

 

[Ensihoitaja]

Did CT confirm it was a hemorrhagic stroke?

 

[IsraelEMS]

Yes. Diabetic (uncontrolled, his blood sugar was 380), hypertensive, history of TIA. It's so sad when you get that train wreck of a patient. And in CVA there is literally nothing you can do except get them to the ER as quick as possible. We opened the CVA protocol at the hospital and went as fast as humanly possible. When we gave the report to the dr about him taking the aspirin I got the "you have got to be kidding me" look. If people didn't do dumb things I wouldn't have much of a job.

 

[Aprz]

I think it's actually pretty common for previous ischemic stroke patients or patients at risk for ischemic stroke to take aspirin, plavix, or both. *shrug* If the patient is awake, talking, only a headache and hemiparesis, I would say he's doing pretty good considering he has a bleed.

 

[berkeman]

The thing is the guy had a history of previous TIAs. Why did he even have aspirin in the house?

Diabetic (uncontrolled, his blood sugar was 380), hypertensive, history of TIA.

I think it's actually pretty common for previous ischemic stroke patients or patients at risk for ischemic stroke to take aspirin, plavix, or both.

Agreed, it doesn't seem like the Hx of TIAs would contraindicate ASA. The hypertension and diabetes might, but not the TIAs.

 

[Chris EMT J]

My CVA pt took aspirin for his headache. Then he called us and said that the headache was worse now and that he could no longer use his right arm or leg. The thing is the guy had a history of previous TIAs. Why did he even have aspirin in the house? Thank G-d he was still alive by the time we got him to the hospital but in the VERY short transport time it was headed into catastrophe.

TIAs do have a significant increase likelihood of stroke. Strokes are ether a bleed or clot. If patient has a hyper coagulation status then it may be a good thing to have. In this case it's unfortunate he did have a hemorrhagic stroke but history of TIAs shouldn't be a contraindication of aspirin.

 

[Akulahawk]

I would say that given that the patient probably had no idea that the headache was a bleed, it was probably reasonable that aspirin was taken for the headache symptom. The best thing the patient did was call for help because of the worsening headache and hemiparesis and that you were told that aspirin had been taken. While the aspirin certainly isn't helping things, at least it can possibly be compensated for because the stroke team KNOWS the patient took aspirin.

IMO, as long as the TIAs weren't small bleeds, the TIAs wouldn't likely have resulted in a contraindication for aspirin.

 

[Tigger]

Man imagine having a history of stroke and then being placed on anticoagulants.

 

[IsraelEMS]

He didn't actually tell us that he took the aspirin until I asked what he had taken for the pain. Then he told me he took the aspirin and said it didn't help and now the pain was worse.

Also, aspirin is not commonly used as a pain killer here. The fact that he took it for a headache is surprising in that regard as well. Usually it is used more therapeutically.