High-dose intravenous naloxone for the treatment of acute ischemic stroke.

2,123

483

Purpose-Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. Methods-Members of the panel were appointed

Section: Neuroprotective Agentsmentioning

confidence: 96%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams

Zoppo²,

Alberts

et al. 2007

2,123

483

“…764 Although a dose-escalation study of naloxone found the medication to be safe, no signal of efficacy was noted. 765 Similarly, no benefit was noted in trials of the opioid antagonist nalmefene. 472,766 Free radicals produced during cerebral ischemia are well-known mediators of neuronal injury.…”

Section: Pharmacological Agentsmentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

5,372

1,801

Background and Purpose-The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods-Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. Results-The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 12, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The Executive Summary is available as an online-only Data Supplement with this article at http://stroke.ahajournals.org/lookup/suppl/ doi:10.1161/STR.0b013e318284056a/-/DC1.The American Heart Association requests that this document be cited as follows: Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; on behalf of the American Heart Association Stroke Council, Council on Cardio...

“…[1][2][3] The National Institutes of Health (NIH) Stroke Scale is probably the most frequently used measure of stroke impairment. 1,[5][6][7][8] This stroke-specific scale has been widely used in clinical trials to measure baseline severity or progress associated with investigational therapies. [5][6][7][8] A recent study by Muir et al 9 shows that baseline NIH Stroke Scale predicts 3-month outcomes (alive at home, alive in care, or dead).…”

mentioning

confidence: 99%

“…1,[5][6][7][8] This stroke-specific scale has been widely used in clinical trials to measure baseline severity or progress associated with investigational therapies. [5][6][7][8] A recent study by Muir et al 9 shows that baseline NIH Stroke Scale predicts 3-month outcomes (alive at home, alive in care, or dead). Individuals who scored greater than 13 on the NIH Stroke Scale had very poor functional outcomes (alive in care or death) compared with those who scored 13 or less.…”

mentioning

confidence: 99%

Prediction of Functional Outcome After Stroke

Lai

Duncan

Keighley

1998

Background and Purpose-This study compared the ability of 2 stroke impairment scales, Orpington Prognostic Scale and National Institutes of Health (NIH) Stroke Scale, to predict disability as measured by the Barthel activities of daily living (ADL) Index and higher level of self-reported physical functioning as measured by the SF-36 physical functioning index (PFI) at 1, 3, and 6 months after stroke. Methods-The participants in this ongoing study are 184 individuals who sustained an eligible stroke and were recruited for the Kansas City Stroke Study. All patients were prospectively evaluated using standardized assessments at enrollment (within 14 days of stroke onset) and followed at 1, 3, and 6 months after stroke. Coefficient of determination (R 2 ) was used to assess the ability of the 2 stroke scales to prognosticate outcomes. Results-Means and SDs of the Orpington Prognostic Scale and NIH Stroke Scale measured at baseline were 3.6Ϯ1.31 and 5.5Ϯ4.58, respectively. The Spearman's rank correlation between the 2 baseline measures was 0.83 (Pϭ0.0001). The Orpington Prognostic Scale and the NIH Stroke Scale explained well the variance in Barthel ADL Index (PϽ0.001). However, the Orpington Prognostic Scale explained more variance than did the NIH Stroke Scale. Similarly, the Orpington Prognostic Score explained more variance in higher level of physical function than did the NIH Stroke Scale. The amount of variance in Barthel ADL Index and SF-36 PFI, which were explained by both stroke severity measures, decreased over time. Conclusions-Our results demonstrate that in a sample of mostly mild and moderate strokes, the Orpington Prognostic Scale compared with the NIH Stroke Scale is simpler to use and is a slightly better predictor of ADL and higher levels of physical function.