Ischemic stroke medical therapy: Difference between revisions

	Ischemic Stroke Microchapters
Main Stroke Page
Transient ischemic attack
Hemorrhagic Stroke Page
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Stroke from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
CT
MRI
Echocardiography
Ultrasound
Other Imaging Findings
Treatment
Early Assessment
Medical Therapy
Surgery
Rehabilitation
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
AHA/ASA Guidelines for Stroke
Case Studies
Case #1
Ischemic stroke medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Ischemic stroke medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Ischemic stroke medical therapy
CDC on Ischemic stroke medical therapy
Ischemic stroke medical therapy in the news
Blogs on Ischemic stroke medical therapy
Directions to Hospitals Treating Stroke
Risk calculators and risk factors for Ischemic stroke medical therapy

← Older edit Newer edit →

VisualWikitext

Revision as of 14:29, 22 November 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S [2]

Overview

Treatment of stroke is occasionally with thrombolysis ("clot buster"), but usually with supportive care (physiotherapy and occupational therapy) and secondary prevention with antiplatelet drugs (aspirin and often dipyridamole), blood pressure control, statins and anticoagulation (in selected patients).^[1]

Medical Therapy

Ischemic Stroke

For AHA/ASA guidelines for Intravenous Fibrinolysis in patients with ischemic stroke, please click here
For AHA/ASA guidelines for General Supportive Care and Treatment of Acute Complications in patients with ischemic stroke, please click here
For AHA/ASA guidelines on anticoagulants usage in patients with ischemic stroke, please click here
For AHA/ASA guidelines on antiplatelets usage in patients with ischemic stroke, please click here
For AHA/ASA guidelines on neuroprotective agents in patients with ischemic stroke, please click here
For AHA/ASA guidelines on General Stroke Care in patients with ischemic stroke, please click here


Medical treatment	Drug class	Recommendations
Medical treatment	Drug class	Acute	Long-Term
Reperfusion therapy	Tissue plasminogen activator (t-PA)	Recommended within 3-4.5 hours of onset of ischemic stroke in eligible patients^[2]^[3]^[4]^[5]^[6]^[7]	None
Antithrombotic agents	Antiplatelet agents	Oral administration of aspirin (initial dose is 325 mg) is recommended within 24 to 48 hours after stroke onset in most patients^[2] Aspirin is contraindicated in patients with ischemic stroke within 24 hours of t-PA administration^[2] DAPT therapy (aspirin and clopidogrel) is recommended for 90 days in patients with symptomatic intracranial large artery disease	Long term therapy with clopidogrel or aspirin extended release dipyridamole may be used for secondary prevention of non cardioembolic stroke
Antithrombotic agents	Anticoagulants	Parenteral or oral anticoagulation is not recommended within 48 hours of onset of ischemic stroke^[8]	Oral anticoagulants may be used for secondary prevention of ischemic stroke in patients with atrial fibrillation or other cardioembolic disease^[9]
Antilipid therapy	Statins	Among patients already taking statins at the time of onset of ischemic stroke, continuation of statin therapy during the acute period is reasonable^[2]	Long term management of ischemic stroke with high intensity statins may be recommended for patients with atherosclerotic disease Patients who cannot tolerate high intensity dose, medium or low intensity statins may prove beneficial
Antihypertensive therapy	Intravenous antihypertensives (Labetolol, nitroprusside)	Used to control high blood pressure in patients with BP>185/110 mmHg before starting t-PA^[2]	Long term oral antihypertensives may be used after 24 hours of ischemic stroke in patients having history of hypertension
Antihypertensive therapy	Oral antihypertensive therapy	Recommended after 24 hours in patient having hypertension	Long term oral antihypertensives may be used after 24 hours of ischemic stroke in patients having history of hypertension
Antihyperglycemic agents	Insulin	May be used to control blood glucose between range of 140-180 mg/dl since hyperglycemia is associated with worst outcome in patients with acute ischemic stroke^[2]	Long term oral antidiabetic may be used for secondary prevention of ischmeic stroke in patients with diabetes mellitus

References

↑ Hackam DG, Spence JD (2007). "Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study". Stroke. 38 (6): 1881–5. doi:10.1161/STROKEAHA.106.475525. PMID 17431209.
↑ ^2.0 ^2.1 ^2.2 ^2.3 ^2.4 ^2.5 Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM; et al. (2013). "Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 44 (3): 870–947. doi:10.1161/STR.0b013e318284056a. PMID 23370205.
↑ "Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group". New England Journal of Medicine. 333 (24): 1581–7. 1995. PMID 7477192.
↑ Dubinsky, R (2006). "Mortality of stroke patients treated with thrombolysis: analysis of nationwide inpatient sample". Neurology. 66 (11): 1742–1744. PMID 16769953. Unknown parameter |coauthors= ignored (help); |access-date= requires |url= (help)
↑ "Position Statement on the Use of Intravenous Thrombolytic Therapy in the Treatment of Stroke". American Academy of Emergency Medicine. Retrieved 2008-01-25.
↑ Wardlaw JM, Murray V, Berge E, del Zoppo GJ (2014). "Thrombolysis for acute ischaemic stroke". Cochrane Database Syst Rev. 7: CD000213. doi:10.1002/14651858.CD000213.pub3. PMC 4153726. PMID 25072528.
↑ Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E; et al. (2014). "Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials". Lancet. doi:10.1016/S0140-6736(14)60584-5. PMID 25106063.
↑ Paciaroni M, Agnelli G, Micheli S, Caso V (2007). "Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials". Stroke. 38 (2): 423–30. doi:10.1161/01.STR.0000254600.92975.1f. PMID 17204681. ACP JC synopsis
↑ Hart RG, Pearce LA, Aguilar MI (2007). "Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation". Ann. Intern. Med. 146 (12): 857–67. PMID 17577005.

Template:WS Template:WH

[1] Hackam DG, Spence JD (2007). "Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study". Stroke. 38 (6): 1881–5. doi:10.1161/STROKEAHA.106.475525. PMID 17431209.

[pmid23370205-2] 2.0 ^2.1 ^2.2 ^2.3 ^2.4 ^2.5 Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM; et al. (2013). "Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 44 (3): 870–947. doi:10.1161/STR.0b013e318284056a. PMID 23370205.

[3] "Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group". New England Journal of Medicine. 333 (24): 1581–7. 1995. PMID 7477192.

[Dubinsky06-4] Dubinsky, R (2006). "Mortality of stroke patients treated with thrombolysis: analysis of nationwide inpatient sample". Neurology. 66 (11): 1742–1744. PMID 16769953. Unknown parameter |coauthors= ignored (help); |access-date= requires |url= (help)

[5] "Position Statement on the Use of Intravenous Thrombolytic Therapy in the Treatment of Stroke". American Academy of Emergency Medicine. Retrieved 2008-01-25.

[pmid25072528-6] Wardlaw JM, Murray V, Berge E, del Zoppo GJ (2014). "Thrombolysis for acute ischaemic stroke". Cochrane Database Syst Rev. 7: CD000213. doi:10.1002/14651858.CD000213.pub3. PMC 4153726. PMID 25072528.

[pmid25106063-7] Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E; et al. (2014). "Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials". Lancet. doi:10.1016/S0140-6736(14)60584-5. PMID 25106063.

[pmid17204681-8] Paciaroni M, Agnelli G, Micheli S, Caso V (2007). "Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials". Stroke. 38 (2): 423–30. doi:10.1161/01.STR.0000254600.92975.1f. PMID 17204681. ACP JC synopsis

[pmid17577005-9] Hart RG, Pearce LA, Aguilar MI (2007). "Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation". Ann. Intern. Med. 146 (12): 857–67. PMID 17577005.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

@@ Line 7: / Line 7: @@
 ==Medical Therapy==
 ==Ischemic Stroke==
+'''For AHA/ASA guidelines for Intravenous Fibrinolysis in patients with ischemic stroke, please''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#Intravenous Fibrinolysis|click here]]<br>
+'''For AHA/ASA guidelines for General Supportive Care and Treatment of Acute Complications in patients with ischemic stroke, please''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#General Supportive Care and Treatment of Acute Complications|click here]]<br>
+'''For AHA/ASA guidelines on anticoagulants usage in patients with ischemic stroke, please ''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#Anticoagulants|click here]]<br>
+'''For AHA/ASA guidelines on antiplatelets  usage in patients with ischemic stroke, please ''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#antiplatelets|click here]]<br>
+'''For AHA/ASA guidelines on neuroprotective agents in patients with ischemic stroke, please ''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#neuroprotective agents|click here]]<br>
+'''For AHA/ASA guidelines on General Stroke Care in patients with ischemic stroke, please ''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#General Stroke Care|click here]]
 {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
 |+
@@ Line 69: / Line 75: @@
 |-
 |}
-'''For AHA/ASA guidelines for Intravenous Fibrinolysis in patients with ischemic stroke, please''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#Intravenous Fibrinolysis|click here]]<br>
-'''For AHA/ASA guidelines for General Supportive Care and Treatment of Acute Complications in patients with ischemic stroke, please''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#General Supportive Care and Treatment of Acute Complications|click here]]<br>
-'''For AHA/ASA guidelines on anticoagulants usage in patients with ischemic stroke, please ''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#Anticoagulants|click here]]<br>
-'''For AHA/ASA guidelines on antiplatelets  usage in patients with ischemic stroke, please ''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#antiplatelets|click here]]<br>
-'''For AHA/ASA guidelines on neuroprotective agents in patients with ischemic stroke, please ''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#neuroprotective agents|click here]]<br>
-'''For AHA/ASA guidelines on General Stroke Care in patients with ischemic stroke, please ''' [[AHA/ASA guideline recommendations for of Early management of acute ischemic stroke#General Stroke Care|click here]]
 ==References==