Carotid artery stenosis – should I have diagnosed it earlier?

11th February 2021, Dr Chee L Khoo

CVA

We all have come across this awful scenario. Patient was admitted to hospital with a TIA or a stroke due to significant carotid stenosis. As good caring GPs, we looked back and wonder whether we should have known about the stenosis. After all, these patients often have other hallmarks of atherosclerosis, coronary artery disease or peripheral arterial disease and the usual cardiovascular risk factors and we should have suspected carotid stenosis.…

Stroke prevention in T2D – REWINDing the clock?

14th March 2020, Dr Chee L Khoo

Despite significant reduction in cardiovascular events over the last 20 years in the general population, patients with diabetes still has 1.5-2 times the risk of cardiovascular events and cardiovascular mortality compared with the general population. It was pretty exciting when two classes of the new anti-diabetic medications have been shown in a number of landmark trials to reduce composite cardiovascular events patients with type 2 diabetes (T2D) and previous cardiovascular disease or patients with T2D with multiple cardiovascular risks.…

Patent foramen ovale – to close or not to close?

25th December 2018, Dr Chee L Khoo

After the acute management of an ischaemic stroke, what follows is the diagnostic process to find the underlying cause and secondary prevention of further strokes. In younger patients and in patients whose atherosclerotic burden is low, the search for a cause can be challenging.  Some of the rarer causes of stroke and cardioembolic causes (including atrial fibrillation) needs to be excluded.…

Aspirin use prevents serious CV events in diabetes but…

15th September, 2018, Dr Chee L Khoo

There is definitely a role for aspirin in preventing cardiovascular (CV) events in patients who already had a CV event (secondary prevention).  There is always a risk of gastrointestinal and intracranial bleeding.  Because the risk of another event after the first is often significantly higher, when one works out the risk benefit ratio, the benefits of aspirin use usually wins.…

Stroke Prevention – are two agents better than one?

15th August 2018, Dr Chee L Khoo

Following an acute coronary event we know that two anti-platelets are better than aspirin alone in preventing further coronary events. What about a cerebro-vascular events? Following a mild CVA or a TIA, we would normally commenced aspirin to prevent another stroke especially in the first 90 days. Would adding another agent to aspirin be better in preventing further strokes?…