Revised Guidelines for Stroke Treatment

Intravenous delivery of an approved clot-busting drug remains the most beneficial proven intervention for ischemic stroke, according to updated guidelines.

The American Heart Association (AHA, Dallas, TX, USA) /American Stroke Association (Dallas, TX, USA) guidelines focus on the crucial first hours from the time an ischemic stroke occurs through emergency evaluation and treatment in a hospital. The new guidelines suggest emergency medical personnel perform a quick stroke assessment, draw blood, and alert the hospital that a patient with a suspected stroke is coming. Patients should also be transported to the nearest appropriate hospital for emergency stroke care even if that means bypassing the closest facility or calling for air evacuation.

The guidelines also recommend that hospitals should develop emergency stroke protocols so patients can be assessed and treated within 60 minutes of arrival in an emergency treatment center, and that patients should receive early and carefully chosen treatments for abnormal blood pressure, fever or abnormal blood sugar levels, which can negatively affect stroke outcome.

The proven treatment for ischemic stroke, intravenous delivery of the clot-busting drug tissue plasminogen activator (tPA), is only approved to be used within three hours of symptom onset; although other clot-dissolving drugs are being tested, none has been established as effective. The panel said other techniques – mechanical devices and intra-arterial administration (IA) of tPA – are becoming more widely available and should be considered for patients with moderate-to-severe strokes who arrive at the hospital too late to receive intravenous tPA.

"We are pushing for the fastest possible treatment because 'time is brain.' For every minute that goes by, the likelihood of a poorer outcome increases, said Harold P. Adams, Jr., M.D., chairman of the writing group.

The revised guidelines include comments about palliative or comfort care of a patient with a devastating brain injury. "We included this in the document so that physicians may recognize that they can take measures to not prolong suffering or dying in a patient whose extensive brain injury will result in a fatal outcome,” Dr. Adams added.


Related Links:
American Heart Association
American Stroke Association