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Le tue opinioni sono il nostro valore aggiunto!
Canadian Association of Emergency Physicians Position Statement on Acute Ischemic Stroke
12 AprLet’s see what they say about thrombolitic therapy and administration timing.
THROMBOLYTIC THERAPY WITHIN 3 HOURS OF STROKE SYMPTOM ONSET
Summary of Evidence
Recommendations
MEDEST COMMENT:
THROMBOLYTIC THERAPY WITHIN 3—4.5 HOURS OF STROKE SYMPTOM ONSET
Summary of Evidence
Recommendations
MEDEST COMMENT:
Even for this part of the statement my agreement is total.
IST 3 that is, at the moment, the largest study on thrombolytic therapy for ischemic stroke is a total contradiction in terms of evidence about benefit and major bleeding events.
Good outcome in the first 3 hrs, a majority of adverse events between 3 and 4,5 hrs and again beneficial between 4,5 and 6 hrs. Just one consideration: the results are not suitable for clinical practice.
So “Thrombolytic therapy for acute ischemic stroke patients should not be routinely offered for the treatment of acute ischemic stroke for patients if administered beyond three hours of stroke symptom onset“.
This is in contrast with the 2013 AHA/ASA Guidelines for the Early Management of Patients With Acute Ischemic Stroke that states:
Intravenous rtPA (0.9 mg/kg, maximum dose 90 mg) is recommended for administration to eligible patients who can be treated in the time period of 3 to 4.5 hours after stroke onset (Class I; Level of Evidence B). The eligibility criteria for treatment in this time period are similar to those for people treated at earlier time periods within 3 hours, with the following additional exclusion criteria: patients >80 years old, those taking oral anticoagulants regardless of INR, those with a baseline NIHSS score >25, those with imaging evidence of ischemic injury involving more than one third of the MCA territory, or those with a history of both stroke and diabetes mellitus.
Bottom line:
I really like this Statement and think that is one of best available policy about thrombolytic therapy and ischemic stroke.
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