Recommendations for the Early Management of Acute Ischemic Stroke: A Consensus Statement for Healthcare Professionals from the Indian Stroke Association

Khurana, Dheeraj; Padma, M. V.; Bhatia, Rohit; Kaul, Subhash; Pandian, Jeyaraj Durai; Sylaja, PN; Arjundas, Deepak; Uppal, Ashok; Pradeep, Vayyattu G.; Suri, Vinit; Nagaraja, D; Alurkar, Anand; Narayan, Sunil

doi:10.1177/2516608518777935

Cited by 19 publications

(22 citation statements)

References 168 publications

(140 reference statements)

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“…It is considered a worldwide pandemic since it is one of the leading causes of disability and mortality [4]. Stroke prevalence rates in India are expected to range from eighty four-two hundred sixty-two strokes every 100,000 persons in remote regions and from three hundred thirty four-four hundred twenty-four strokes every 100,000 persons in metropolitan areas [5]. According to latest population-based surveys, the incidence rate is 119-145/100,000(3).…”

Section: Introductionmentioning

confidence: 99%

Comparison the Impact on TENS and Conventional Physiotherapy in Stroke Patients with Upper Limb Dysfunctions: A Research Protocol

Lalwani

Vardhan

Bele

2021

JPRI

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Background: Stroke is a sudden neurological explosion resulting from poor blood flow perfusion to the brain. Stroke prevalence rates in India are expected to range from eighty-four to two hundred sixty-two strokes every 100,000 persons in remote regions and from three hundred thirty-four to four hundred twenty-four strokes every 100,000 persons in metropolitan areas. It causes brain cells to die abruptly due to inadequate oxygen and is a neurological condition characterized by blood flow blockage. Aim & Objective: to examine the impact of TENS (Transcutaneous Electrical Nerve Stimulation), EMS (Electrical Muscle Stimulation), and ROM (Range of Motion) exercises on upper-limb functioning in hemi paretic stroke victims. Methods: The current study subjects (n=39) would be stroke survivors. Patients will be divided into three groups: group A will receive TENS, group B will receive EMS, and group C will get ROM exercises. The protocol will cover 2 weeks of treatment. We will assess upper limb functioning, activities of everyday living (ADLs), and mental condition at frequent intervals. By using the MHQ (Michigan Hand Outcomes Questionnaire), Hand Grip Strength (HGS), Brunnstrom Hand Function Recovery stages. Results: The successful completion of this study will provide evidence on the best treatment strategy for stroke patients to improve their upper extremity motor function using individual TENS, EMS, or ROM exercises. Conclusion: This study will be beneficial to treat Stroke patients with upper limb dysfunction by treating by TENS modality which might be an option for EMS treatment.

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Section: Introductionmentioning

confidence: 99%

Comparison the Impact on TENS and Conventional Physiotherapy in Stroke Patients with Upper Limb Dysfunctions: A Research Protocol

Lalwani

Vardhan

Bele

2021

JPRI

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“…National guidelines universally recommend well-organised, interdisciplinary, acute stroke unit (ASU) care [1][2][3][4], based upon consistent evidence from systematic reviews and individual trials showing improved survival and functional recovery [5,6], with the treatment effect being consistent across a range of patient characteristics within all age groups and different stroke subtypes [7][8][9][10]. However, such care is absence or only partially established in many hospitals around world [11].…”

Section: Introductionmentioning

confidence: 99%

Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study

Ouyang

Zhang

Wang

et al. 2020

Journal of the Neurological Sciences

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Access to acute stroke unit (ASU) care is known to vary worldwide. We aimed to quantify regional variations in the various components of ASU care. Method: Secondary analysis of the Head Positioning in acute Stroke Trial (HeadPoST), an international, multicentre, cluster crossover trial of head-up versus head-down positioning in 11,093 acute stroke patients at 114 hospitals in 9 countries. Patients characteristics and 11 standard components of processes of care were described according to ASU admission within and across four economically-defined regional groups (Australia/UK, China [includes Taiwan], India/Sri Lanka, and South America [Brazil/Chile/Colombia]). Variations in process of ASU care estimates were obtained in hierarchical mixed models, with adjustment for study design and potential patient-and hospital-level confounders. Results: Of 11,086 patients included in analyses, 59.7% (n = 6620) had an ASU admission. In China, India/Sri Lanka and South America, ASU patients were older, had greater neurological severity and more premorbid conditions than non-ASU patients. ASU patients were more likely to receive reperfusion therapy and multidisciplinary care within regions, but the components of care varied across regions. With Australia/UK as reference, patients in other regions had a lower probability of receiving reperfusion therapy, especially in India/Sri Lanka (adjusted odds ratio [aOR] 0.27, 95% confidence interval [CI] 0.12-0.63) and multidisciplinary care (mainly in formal dysphagia assessment, physiotherapy and occupational therapy). Conclusion:There is significant variation in the components of stroke care across economically-defined regions of the world. Ongoing efforts are required to reduce disparities and optimise health outcomes, especially in resource poor areas. Clinical trial registration: HeadPoST is registered at ClinicalTrials.gov (NCT02162017).

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“…Table 2 summarizes recommendations regarding EVT and intravenous alteplase from acute stroke management guidelines in the United States, 4 Europe, 2,36 Canada, 3 China, 6,7 and India 5 . Historically, based on evidence that alteplase is superior to placebo in patients not receiving EVT and that treatment with alteplase was allowed in the pivotal trials proving the effectiveness of EVT, previous guidelines strongly recommended giving alteplase in eligible patients undergoing EVT.…”

Section: Discussionmentioning

confidence: 99%

“…In tertiary centers with well‐functioning acute stroke teams, approximately 20% of all ischemic stroke patients are eligible for and treated with intravenous thrombolysis, endovascular thrombectomy (EVT), or both 1 . Alteplase is the only regulatory‐approved agent for intravenous thrombolysis in most countries, and current guidelines strongly recommend both EVT and alteplase in patients with acute ischemic stroke due to large vessel occlusion 2–7 . Both treatments are highly time‐sensitive and even a delay of 15 min is associated with an important reduction in the chance of recovery with functional independence 8–10 …”

Section: Introductionmentioning

confidence: 99%

Endovascular thrombectomy and intravenous alteplase in patients with acute ischemic stroke due to large vessel occlusion: A clinical practice guideline

Busse

Hill

et al. 2022

J Evidence Based Medicine

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Aim Whether or not use of intravenous alteplase in combination with endovascular thrombectomy (EVT) improves outcomes versus EVT alone, for acute stroke patients with large vessel occlusion presenting directly to a comprehensive stroke center, is uncertain. Methods Six randomized trials exploring this issue were published, and we synthesized this evidence to inform a rapid guideline based on the Guidelines International Network principles and guided by the GRADE approach. Results We enlisted an international panel that included 4 patient partners and 1 caregiver, individuals from 6 countries. The panel considered low certainty evidence that EVT alone, relative to EVT with intravenous alteplase, possibly results in a small decrease in the proportion of patients that achieve functional independence and possibly a small increase in mortality. Both effect estimates were downgraded twice due to very serious imprecision. The panel also considered moderate certainty evidence that EVT alone probably decreases symptomatic intracranial hemorrhage, versus EVT with alteplase, and combination therapy was more costly than EVT alone. As a result of the low certainty for improved recovery without impairment and mortality for combination therapy versus EVT alone, and moderate certainty for increased harm with combination therapy, the panel made a weak recommendation in favor of EVT alone for stroke patients eligible for both treatments, and initially presenting directly to a comprehensive stroke center that provides both treatments. Conclusions Consistent with this weak recommendation, optimal patient management will likely often include co‐treatment with intravenous alteplase, depending on local circumstances and patient presentation.

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Recommendations for the Early Management of Acute Ischemic Stroke: A Consensus Statement for Healthcare Professionals from the Indian Stroke Association

Cited by 19 publications

References 168 publications

Comparison the Impact on TENS and Conventional Physiotherapy in Stroke Patients with Upper Limb Dysfunctions: A Research Protocol

Comparison the Impact on TENS and Conventional Physiotherapy in Stroke Patients with Upper Limb Dysfunctions: A Research Protocol

Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study

Endovascular thrombectomy and intravenous alteplase in patients with acute ischemic stroke due to large vessel occlusion: A clinical practice guideline

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