Guidelines for acute ischemic stroke treatment: part II: stroke treatment

Martins, Sheila Cristina Ouriques; Freitas, Gabriel R. de; Pontes-Neto, Octávio Marques; Pieri, Alexandre; Moro, Carla Heloísa Cabral; Jesus, Pedro Antônio Pereira de; Longo, Alexandre Luiz; Evaristo, Eli Faria; Carvalho, João José Freitas de; Fernandes, Jefferson Gomes; Gagliardi, Rubens José; Oliveira‐Filho, Jamary

doi:10.1590/s0004-282x2012001100012

Cited by 53 publications

(69 citation statements)

References 62 publications

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“…The Brazilian Stroke Society proposed recently a classification of referral centers for diagnosis and treatment of acute stroke, including a multidisciplinary team qualified for care and management of high-complexity stroke patients 30 . Stroke unit care can act better than general ward in intervention and maintenance of physiological homeostasis, more attention to preventive measures, selective use of antipyretics, antibiotic medication and insulin, better training and greater dedication of professional staff, and emphasis on patient and family education and involvement in care 31 .…”

Section: Discussionmentioning

confidence: 99%

“…Most patients were discharged home (115, 72.3%), and others died (25,15.7%) or were transferred to other hospital (19, 11.9%). Ischemic and hemorrhagic stroke were diagnosed in (129, 81.1%) and (30,18.9%) patients, respectively. Anterior circulation stroke was documented in (132, 83.01%) patients, followed by posterior circulation (27,16.9%).…”

Section: Study Population and Stroke Characteristicsmentioning

confidence: 99%

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Predictors of pneumonia in acute stroke in patients in an emergency unit

Almeida

Bahia

Lima

et al. 2015

Arq. Neuro-Psiquiatr.

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Objective To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results 159 patients (18-90 years) were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001), higher National Institute of Health Stroke Scale (NIHSS) (p = 0.047) and, lower Glasgow Coma Score (GCS) (p < 0.0001). Patients with pneumonia had longer hospitalization (p < 0.0001). Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002). Conclusion Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

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Section: Discussionmentioning

confidence: 99%

Section: Study Population and Stroke Characteristicsmentioning

confidence: 99%

Predictors of pneumonia in acute stroke in patients in an emergency unit

Almeida

Bahia

Lima

et al. 2015

Arq. Neuro-Psiquiatr.

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“…A certified neurologist in NIHSS examination evaluated all patients, and eligibility to thrombolysis in both groups was individually determined based on the inclusion and exclusion criteria described in the National Institute of Neurological Disorders and Stroke (NINDS), European Cooperative Acute Stroke Study (ECASS III) and current guidelines 1,2,5,6 . Outcome variables were: 1) the presence of any hemorrhagic transformation (HT) between 24 and 36 hours after rtPA infusion characterized by hemorrhagic infarction (small petechiae or more confluent petechiae) and parenchymal hemorrhage (hematoma involved less than 30% of the infarcted area or involved at least 30% of the infarcted area or a clot was detected at some distance from the infarcted area) 7,8 ; 2) the presence of symptomatic HT (SHT) between 24 and 36 hours after rtPA infusion considering NIHSS and brain CT, characterized by brain imaging evidence of HT with clinical worsening, indicated by an NIHSS score increase of at least four points in the next 36 hours compared with the lower punctuation 8 ; 3) NIHSS after 24 hours of treatment; 4) the independence on discharge, considering modified Rankin score (mRS) ≤ 2; 5) death until three months after stroke onset.…”

Section: Methodsmentioning

confidence: 99%

“…Current guidelines suggest that BP must be maintained bellow 180/105 mmHg when recombinant tissue plasminogen activator (rtPA) is used 1,2 . There are large numbers of drugs to control BP in this setting, but in the public Health Brazilian System, beside the continuous improving in the assistance of AIS, the intravenous medications available are metoprolol and sodium nitroprusside 2 .…”

mentioning

confidence: 99%

Sodium nitroprusside: low price and safe drug to control BP during thrombolysis in AIS

Koslyk

Ducci

Nóvak

et al. 2015

Arq. Neuro-Psiquiatr.

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The blood pressure (BP) control is an important goal in the management of the acute ischemic stroke (AIS). Current guidelines suggest that BP must be maintained bellow 180/105 mmHg when recombinant tissue plasminogen activator (rtPA) is used 1,2 . There are large numbers of drugs to control BP in this setting, but in the public Health Brazilian System, beside the continuous improving in the assistance of AIS, the intravenous medications available are metoprolol and sodium nitroprusside 2 . Sodium nitroprusside (SN) was previously related to intracranial hypertension, rebound effect and BP control liability 3 . On the other way, SN is a low price, spread in all country and could improve the blood flow in ischemic region 4 . The aim of the study is to analyze if the use of SN to BP control is safe in patients with AIS submitted to intravenous rtPA. MethodA case-control study where 60 patients composed the sample, all them had ischemic stroke (IS) and were submitted to intravenous rtPA between July 2010 and December 2011 in the Hospital de Clinicas from the Federal University of Parana in Curitiba (HC-UFPR), Brazil. Patients were selected from the Stroke Data Bank of the Neurology Division from the HC-UFPR. They were retrospectively selected and pared by age, gender and admission National Institute of Health Stroke Scale (NIHSS) in two groups: Thirty patients in the Control Group (CG) with BP levels below 180/105 mmHg, without requiring intravenous antihypertensive drug to control the BP previous or during the rtPA infusion. Thirty patients in SN Group (SNG) with BP levels over 180/105 mmHg requiring ABStrActThis study analyzes the use of sodium nitroprusside (SN) as an option to reduce blood pressure (BP) below 180/105 mmHg during the management of acute ischemic stroke (AIS) in patients submitted to intravenous thrombolysis. Method: The sample was composed by 60 patients who had AIS and were submitted to intravenous rtPA, split in two groups: half in the control group (CG) with BP < 180/105 mmHg and half in SN group with BP > 180/105 mmHg. Outcome variables were any hemorrhagic transformation (HT); the presence of symptomatic HT, National Institute of Health Stroke Scale (NIHSS) after 24 hours of treatment; the independence on discharge and death until three months after stroke onset. Results: There were no statistical differences between both groups to any of the outcome variables analyzed. Conclusion: The SN might be safe for BP control during thrombolysis to AIS.Keywords: ischemic stroke, thrombolytic therapy, hypertension, sodium nitroprussite, safety.reSuMo Este estudo analisa o uso de nitroprussiato de sódio (NS) como uma opção para reduzir a pressão arterial (PA) durante o tratamento do AVC isquêmico agudo (AVCi) em pacientes submetidos à trombólise intravenosa (rtPA). Método: A amostra foi composta por 60 pacientes que tiveram AVCi e foram submetidos a rtPA, dividida em dois grupos: 30 pacientes no grupo controle (GC), com PA < 180/105 mmHg e 30 pacientes no grupo NS com PA > 180/105 mmHg. As variáveis a...

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“…The authors evaluated the accuracy of POC measurements to detect INR measurements lower or equal than 1.7. This INR threshold is recommended for decision-making by the American Heart Association/American Stroke Association (AHA/ASO) as well as by Brazilian guidelines, in patients otherwise eligible for intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) 2,3 . According to these guidelines, an INR .1.7 or a prothrombin time .15 seconds are exclusion criteria for intravenous thrombolysis within 3 hours from symptom onset.…”

mentioning

confidence: 99%

Potential impact of point-of-care INR testing on intravenous thrombolysis

Conforto

2014

Arq. Neuro-Psiquiatr.

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Guidelines for acute ischemic stroke treatment: part II: stroke treatment

Cited by 53 publications

References 62 publications

Predictors of pneumonia in acute stroke in patients in an emergency unit

Predictors of pneumonia in acute stroke in patients in an emergency unit

Sodium nitroprusside: low price and safe drug to control BP during thrombolysis in AIS

Potential impact of point-of-care INR testing on intravenous thrombolysis

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