And here we are with the 4th episode of the F.A.R. series. If you accidentally lost the first two episodes you can find them here:

#1 Cardiac Arrest

#2 Airway Management

In this episode we’ll explore the best articles of 2014 about:

Stroke

Before starting we have to declare (if you are not aware of) that MEDEST is quite skeptical about the previous studies that are at the basis of thrombolytic therapy (Lo strano caso del trombolitico nell’ictus cerebrale ischemico, Pubblicate le nuove linee guida AHA/ASA sul trattamento precoce dello Stroke: nessuna nuova ed ancora qulache dubbio!, L’uso del trombolitico nello stroke. Stiamo giocando con la salute dei nostri pazienti?, rt-PA e Stroke: IST-3 l’analisi dei risultati). This can represent a potential bias on the choice of the articles. We also think that the actual evidences, and the consequent guidelines, are strongly influenced by commercial interests and not well supported from evidences that demonstrates how benefits outweight harms. We hope that 2015 will be the first year of a new era for stroke management, an era of well done studies producing strong evidences to achieve good neurological targets in all stroke patients.

In the first part we mention the litterature about thrombolytic therapy

• Thrombolytic Therapy in  Acute Stroke
• Questions about authorisation of alteplase for ischaemic stroke
• Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative
• Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice
• 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
• Association Between Hyperoxia and Mortality After Stroke- A Multicenter Cohort Study

And then the articles about endovascular therapy:

• A meta-analysis of prospective randomized controlled trials evaluating endovascular therapies for acute ischemic stroke
• A research roadmap of future endovascular stroke trials
• Endovascular therapy for acute ischemic stroke is indicated and evidence based: a position statement
• Reperfusion therapies of acute ischemic stroke: potentials and failures
• Stroke- an emphasis on guidelines
• A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke
• Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

And now as anticipated in the title the 2015 ACEP Clinical Policy on Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department. Those freshly published guidelines give answer at two of most recurrent questions on stroke treatment:

1. Is IV tPA safe and effective for acute ischemic stroke patients if given within 3 hours of symptom onset?

2. Is IV tPA safe and effective for acute ischemic stroke patients treated between 3 to 4.5 hours after symptom onset?

Download and read the full policy to discover the recommendations made and based on the strength of the available data.

DISCLOSURE: MEDEST strongly encourage AWARNESS reading the propoused articles.

Abstracts are often misleading and articles potentially biased. Even this selection is not immune from potential bias (just human factors not commercial interests).

So download the full text and read it carefully to have a clear and complete opinion of the related topics.

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Tags: ACR, advanced airway management, Antiaggregazione, antiplatelets, arresto cardiaco, clinical decision rules, emergency medicine, emergenza sanitaria territoriale, gestione avanzata delle vie aeree, litterature review, medicina d'urgenza, prehospital emergency medicine, sindromi coronariche acute, Stroke