Lege Artis Medicinae

[THE TREATMENT OF ACUTE ISCHEMIC STROKE BASED ON CURRENT GUIDELINES]

SZEGEDI Norbert, MAY Zsolt, ÓVÁRY Csaba

FEBRUARY 20, 2005

Lege Artis Medicinae - 2005;15(02)

[Cerebrovascular diseases are third among the most frequent causes of mortality in developed countries and represent the most common cause of disability in adulthood. 80% of all acute stroke cases are of ischemic origin. The proven significant efficacy of intravenous thrombolysis with rt-PA in the NINDS rt-PA Stroke Trial was the cornerstone of the treatment of acute ischemic stroke, followed by several recommendations. From this time on, the attention shifted to early and appropriate recognition of symptoms and to organizing a quickly reacting emergency medical system in order to maximize the number of those patients transported immediately to the nearest stroke center to have the opportunity to be treated within three hours after their symptom onset. Specialized stroke facilities have documented benefit over other forms of stroke management concerning survival rates, but they need coordinated continuous multidisciplinary care for the patients, availability of CT scanner, laboratory examinations including tests of hemostasis, intensive care unit and well-trained stroke neurologists on 24-hours-a-day basis. Thrombolysis in these stroke centers with intravenous 0,9 mg/kg rt-PA improves the outcome of acute stroke with 30%. Although new guidelines strongly recommend the thrombolysis of selected ischemic stroke patients, the only evidence-based treatment of this condition has not yet become a part of the routine stroke management in Hungary. Regarding other specific antithrombotic therapeutic approaches, anticoagulation has the most contradictory status: in spite of well-defined theoretic considerations there are no evidence-based data in favour of routine anticoagulation in acute ischemic stroke, neither with heparin nor with low molecular weight heparins or heparinoids, while aspirin given within 24-48 hours after stroke onset was shown to have a significant but modest benefit. No data support the treatment with hemodilution or the administration of neuroprotective drugs. Evidence accumulating continuously determine the principles of general care including the methods and the targets in the acute phase of ischemic stroke regarding respiratory and cardiac care, management of blood pressure and blood glucose levels and body temperature.]

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