Guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association.

Adams, Harold P.; Brott, Thomas G.; Crowell, Robert M.; Furlan, Anthony J.; Gomez, Camilo R.; Grotta, James C.; Helgason, Cathy M.; Marler, John R.; Woolson, Robert F.; Zivin, Justin A.

doi:10.1161/01.str.25.9.1901

Cited by 480 publications

(311 citation statements)

References 191 publications

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“…31,32 Heparin in the setting of thrombolysis for AIS might contribute to the risk of hemorrhage. In MAST-E, 65% of SK-treated patients and 75% of placebo patients received full heparinization.…”

Section: Heparin Might Be Harmfulmentioning

confidence: 99%

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

Lewandowski

Lotfipour

2002

Journal of Stroke and Cerebrovascular Diseases

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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.

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Section: Heparin Might Be Harmfulmentioning

confidence: 99%

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

Lewandowski

Lotfipour

2002

Journal of Stroke and Cerebrovascular Diseases

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“…There is no need to emphasize how important it is to ascertain the form of stroke by physical and neurological examination combined with diagnostic tests. This is the reason why a stroke patient should be treated as a medical emergency, even when having mild symptoms 13,72,73 . Early assessment of stroke subtypes based on the physical and neurological evaluation, as well as skilled use and interpretation of diagnostic tests, are essential 74 .…”

Section: Management In the Emergency Room (Er)mentioning

confidence: 99%

“…It has already been agreed upon "general treatment" as a foundation for early stroke patient management 13,17,22,72 . It includes respiratory and cardiac monitoring, blood pressure control, treatment of elevated intracranial pressure, fluid and metabolic management, metabolic surveillance and fluid administration.…”

Section: General Stroke Treatmentmentioning

confidence: 99%

“…6 Also, acute stroke treatment, primary and secondary prevention, and rehabilitation at specialized wards have been proved to be effective [7][8][9][10][11] . In the past year, several recommendations for stroke management were published [12][13][14][15][16][17][18][19][20][21][22] . These are recommendations proposed by the Croatian Society for Neurovascular Disorders of the Croatian Medical Association; University Department of Neurology, Sestre milosrdnice University Hospital, which is the Reference Center for Neurovascular Disorders of the Croatian Ministry of Health; and the Croatian Stroke Society.…”

Section: Introductionmentioning

confidence: 99%

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Recommendations for Stroke Management

Demarin¹,

Lovrenčić-Huzjan²,

Šerić³

et al. 2000

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“…1994, 1996, 2003, 2005, 2007; The National Institute of Neurological Disorders and Stroke rt‐PA Stoke Study Group, 1995; Levine and Gorman 1999; Alberts et al. 2000, 2005, 2011, 2013; Albers et al.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of regionalized systems for stroke and myocardial infarction

et al. 2015

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BackgroundAcute ischemic stroke (AIS) and ST‐segment elevation myocardial infarction (STEMI) are ischemic emergencies. Guidelines recommend care delivery within formally regionalized systems of care at designated centers, with bypass of nearby centers of lesser or no designation. We review the evidence of the effectiveness of regionalized systems in AIS and STEMI.MethodsLiterature was searched using terms corresponding to designation of AIS and STEMI systems and from 2010 to the present. Inclusion criteria included report of an outcome on any dependent variable mentioned in the rationale for regionalization in the guidelines and an independent variable comparing care to a non‐ or pre‐regionalized system. Designation was defined in the AIS case as certification by the Joint Commission as either a primary (PSC) or comprehensive (CSC) stroke center. In the STEMI case, the search was conducted linking “regionalization” and “myocardial infarction” or citation as a model system by any American Heart Association statement.ResultsFor AIS, 17 publications met these criteria and were selected for review. In the STEMI case, four publications met these criteria; the search was therefore expanded by relaxing the criteria to include any historical or anecdotal comparison to a pre‐ or nonregionalized state. The final yield was nine papers from six systems.ConclusionAlthough regionalized care results in enhanced process and reduced unadjusted rates of disparity in access and adverse outcomes, these differences tend to become nonsignificant when adjusted for delayed presentation and hospital arrival by means other than emergency medical services. The benefits of regionalized care occur along with a temporal trend of improvement due to uptake of quality initiatives and guideline recommendations by all systems regardless of designation. Further research is justified with a randomized registry or cluster randomized design to support or refute recommendations that regionalization should be the standard of care.

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Guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association.

Cited by 480 publications

References 191 publications

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

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

Recommendations for Stroke Management

Effectiveness of regionalized systems for stroke and myocardial infarction

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