Guidelines for Thrombolytic Therapy for Acute Stroke: A Supplement to the Guidelines for the Management of Patients With Acute Ischemic Stroke

Adams, Harold P.; Brott, Thomas G.; Furlan, Anthony J.; Gomez, Camilo R.; Grotta, James C.; Helgason, Cathy M.; Kwiatkowski, Thomas; Lyden, Patrick D.; Marler, John R.; Torner, James C.; Feinberg, William M.; Mayberg, Marc R.; Thies, William

doi:10.1161/01.cir.94.5.1167

Cited by 515 publications

(280 citation statements)

References 44 publications

Supporting

Mentioning

268

Contrasting

Unclassified

Order By: Relevance

“…Even though IV thrombolysis was initially a matter of relative controversy, it has now been endorsed as a class IA level of evidence intervention by the major national guidelines development organizations. 4,5 A Cochrane Database Review including 18 trials (16 double-blind) with a total of 5727 patients who received thrombolytics (IV urokinase, streptokinase, rtPA, or recombinant intra-arterial prourokinase) up to 6 hours after ischemic stroke showed a significant reduction in the proportion of patients who were dead or dependent (modified Rankin Scale [mRS] score, 3-6) at follow-up at 3-6 months (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.75-0.95), despite a significant increase in the odds of death within the first 10 days (OR, 1.81; 95% CI, 1.46 -2.24); most of the deaths were related to symptomatic intracranial hemorrhage (sICH) (OR, 3.37; 95% CI, 2.68 -4.22). 6 In addition, a pooled analysis of 6 major randomized placebo-controlled IV rtPA stroke trials (Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke [ATLANTIS] I and II, European Cooperative Acute Stroke Study [ECASS] I and II, and NINDS I and II), including 2775 patients who were treated with IV rtPA or a placebo within 360 minutes of stroke onset, confirmed the benefit up to 3 hours and suggested a potential benefit beyond 3 hours for some patients.…”

Section: Overview and Rationale For Endovascular Stroke Therapymentioning

confidence: 99%

Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data

Nogueira¹,

Schwamm²,

Hirsch³

2009

AJNR Am J Neuroradiol

121

111

View full text Add to dashboard Cite

SUMMARY:Despite years of research and pioneering clinical work, stroke remains a massive public health concern. Since 1996, we have lived in the era of US Food and Drug AdministrationϪapproved intravenous (IV) recombinant tissue plasminogen activator (rtPA). This treatment, despite its promise, continues to exhibit its limitations. Endovascular therapy has several theoretic advantages over IV rtPA, including site specificity, longer treatment windows, and higher recanalization rates. In this article, we will review the various pharmacologic strategies for acute stroke treatment, providing both a historic context and the state of the art. The drugs will be classified on the basis of their theoretic rationale for therapy. Next, we will review the various devices and strategies for mechanical revascularization with an aim toward comprehensiveness. These range from wire disruption of thrombus to preclinical trials for novel mechanical solutions. This first installment of this 2-part series will end with an analysis of retrograde reperfusion techniques.

show abstract

Section: Overview and Rationale For Endovascular Stroke Therapymentioning

confidence: 99%

Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data

Nogueira¹,

Schwamm²,

Hirsch³

2009

AJNR Am J Neuroradiol

121

111

View full text Add to dashboard Cite

show abstract

“…Se está planejada a terapia com trombolíticos, o controle da TA deve ser rigoroso, visando reduzir o risco potencial de sangramento após sua administração 15,18 . Esta terapia não é recomendada se a TA sistólica é maior que 185 ou se a TA diastólica é maior que 110 mmHg 15,22 .…”

Section: Discussionunclassified

Manejo da hipertensão arterial na isquemia cerebral aguda

Fagundes-Pereyra

Ramos

Malheiro

et al. 1999

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

quadro de hipertensão arterial na fase aguda da isquemia cerebral. Também comentamos as principais condutas nesta fase, com ênfase na tensão arterial (TA). Método: Foram entrevistados 120 médicos da clínica médica e da cirurgia geral, em dez dos maiores Hospitais de Belo Horizonte, em 1997. Todos responderam a um questionário contendo um caso clínico de paciente hipertenso leve, admitido com quadro de isquemia cerebral e tensão arterial de 186x110 mmHg. Os profissionais deveriam optar por reduzir, aumentar ou manter a TA. Resultados: Dos entrevistados, 38 (31,7%) responderam que reduziriam os níveis tensionais, 82 (68,3%) optaram pela manutenção e nenhum aumentaria (p<0,05). Estes índices foram iguais nas duas especialidades. Já em relação ao tempo de formado, observou-se que aqueles com mais de 10 anos de graduação, apresentaram maior tendência a redução da TA (p<0,05), quando comparado aos mais jovens. Conclusão: A redução da TA prejudica a perfusão cerebral, podendo aumentar a área isquêmica ("zona de penumbra"). Concluimos que, apesar de estar a maioria dos médicos ciente da conduta recomendada no manejo da hipertensão arterial na fase aguda dos quadros isquêmios cerebrais 31,7% ainda é uma taxa elevada de médicos despreparados para o atendimento emergencial de isquemia cerebral, considerando os prejuízos trazidos ao paciente em decorrência da conduta inadequada. Talvez o desenvolvimento de unidades especializadas no atendimento desses pacientes ("stroke units") possa melhorar tais índices. PALAVRAS-CHAVE: isquemia cerebral, hipertensão arterial, terapêutica. Management of arterial hypertension in patients with acute ischemic strokeABSTRACT -Purpose: We aimed with study to assess the current clinical practice about the management of high blood pressure in patients in the acute phase of ischemic stroke. We also comment some topics of ischemic stroke treatment. Methods: A case report of a patient admitted 8 hours after onset of ischemic stroke and with blood pressure of 186x110 mmHg was presented to 120 surgeons and clinician. They were asked to decide the best therapeutic option: to increase, decrease or maintenance blood pressure. Results: Thirty-eight physicians (31,7%) considered decreasing blood pressure the best therapeutics, 82 (68,3%) considered maintenance and none decided to increase it (p < 0.05). There was no difference between the two specialties conduct. The physicians, with more than 10 years of graduation, had a tendency to decrease the blood pressure (p <0.05). Conclusion: The maintenance of blood pressure may present a sufficient blood support to compensate brain flow. A high percentage of the physicians (31,7%) do not know about the current concepts of therapeutics considering hypertension in acute ischemic stroke. The development on special units to treat these patients ("stroke units") may eventually decrease the morbimortality rates of ischemic stroke.

show abstract

“…39 Evidence from Phase IV studies 38,41 in centers that follow these guidelines supports the notion that complications are much higher in those patients that are treated outside of accepted protocols (See next article for details).…”

Section: Protocol Violations Are Perilousmentioning

confidence: 90%

“…38 These protocols were a key part of the success of the NINDS trials and are now supported by the American Heart Association. 39 For example, strict blood pressure inclusion criteria (185/110), with standardized monitoring and treatment protocols for the first 24 hours, may have decreased the complication rate without harming patients from hypotension. 40 These types of systems interventions were not reported in the other trials.…”

Section: Protocol Adherence Is Paramountmentioning

confidence: 99%

Lessons learned from multicenter randomized clinical trials with intravenous thrombolysis for acute ischemic stroke

Lewandowski

Lotfipour

2001

Seminars in Cerebrovascular Diseases and Stroke

View full text Add to dashboard Cite

The idea of thrombolysis for acute ischemic stroke dates back to the 1950s. Many different drugs, dosages, routes of administration, and times to treatment have been investigated through the 1980s. This experience led to the recent large randomized trials of intravenous thrombolysis completed in the 1990s, the decade of the brain. Three of the trials used streptokinase, and four trials used recombinant tissue plasminogen activator (rt-PA). In this review, we examine these seven randomized intravenous acute ischemic stroke treatment trials, summarize their results, and draw lessons that might be useful for patient care and in future trials.

show abstract

Guidelines for Thrombolytic Therapy for Acute Stroke: A Supplement to the Guidelines for the Management of Patients With Acute Ischemic Stroke

Cited by 515 publications

References 44 publications

Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data

Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data

Manejo da hipertensão arterial na isquemia cerebral aguda

Lessons learned from multicenter randomized clinical trials with intravenous thrombolysis for acute ischemic stroke

Contact Info

Product

Resources

About