You were a pharmacist working in an acute hospital. A 72-year-old man was admitted for suspected stroke symptoms with right-sided weakness and speech problems. He arrived at the emergency department 83 minutes after symptom onset. He had a past medical history of paroxysmal atrial fibrillation, hypertension, hyperlipidaemia, chronic kidney disease (Stage 3B, Glomerular Filtration Rate (“GFR”) 44 mL/min) and coronary artery disease. His blood pressure and pulse rates were 170/96 mmHg and 110 bpm respectively. He had been on dabigatran 150 mg twice daily for the prevention of stroke. The neurologist and stroke nurse decided to commence intravenous thrombolytic therapy in the emergency department. Initial investigation results were as follows:

• Computerised Tomography (“CT”) scan of the brain showed no evidence of intracranial haemorrhage
• Activated partial thromboplastin time (“APTT”) was 41s (reference range = 27.4 - 37.4s)
• Serum creatinine level was 126 µmol/L (reference range - 65 - 109 µmol/L)

72 year old man

Stroke symptoms: right sided weakness + speech problems

Symptoms started 83 minutes ago

BP 170/96 - High BP - query is he taking any medication for this, and if not why

HR 110 bpm - symptom of AF is fast and irregular heart beat

Medical history:

• Paroxysmal AF
• Hypertension
• Hyperlipidaemia
• CKD - Stage 3B, GFR 44 ml/min
• CAD

There are different clinical stages of AF depending on how advanced it is:

• paroxysmal atrial fibrillation - this comes and goes, usually stopping within 48 hours without any treatment.
• persistent atrial fibrillation - this lasts for longer than seven days, or less when it is treated.
• longstanding persistent atrial fibrillation - continuous atrial fibrillation for a year or longer.
• permanent atrial fibrillation - atrial fibrillation is present all the time and no more attempts to restore normal heart rhythm will be made 

In the natural course of AF, AF commonly progresses from silent and undiagnosed to paroxysmal and subsequently sustained (persistent or permanent) AF. 

NHS Scotland

WebMD

Drug history: Dabigatran 150 mg twice daily for stroke prevention - this is because he has AF which is a key risk factor for stroke

Initial investigations:

• Brain scan showed no haemorrhage: There are two types of stroke - haemorrhagic and ischaemic stroke. The brain scan confirms ischaemic stroke, which can be treated with a thrombolytic. Thrombolytics are contraindicated if there is any bleeding present.

• APTT is a blood coagulation test, his results show that his blood is anti-coagulated, due to the dabigatran he is taking for stroke prevention.

• Serum creatinine: His creatinine levels are high indicating he has renal impairment. This is also confirmed in the question stating he has CKD stage 3B.

kidney.org

Stroke Fund

Check out: Hong Kong Stroke Society - has a risk calculator and links to other HK stroke organisations

https://www.hkmj.org/system/files/hkm1204p92.pdf

https://www3.ha.org.hk/haconvention/hac2012/proceedings/downloads/MC3.2.pdf