PATHWAY STROKE NON HEMORAGIK PDF

The following Key Points to Remember are not impacted by these changes. The benefits of intravenous IV tissue plasminogen activator tPA are time-dependent, and treatment for eligible patients should be initiated as quickly as possible even for patients who may also be candidates for mechanical thrombectomy. IV tPA should be administered to all eligible acute stroke patients within 3 hours of last known normal and to a more selective group of eligible acute stroke patients based on ECASS III exclusion criteria within 4. Centers should attempt to achieve door-to-needle times of Prior to initiation of IV tPA in most patients, a noncontrast head computed tomography CT and glucose are the only required tests.

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The following Key Points to Remember are not impacted by these changes. The benefits of intravenous IV tissue plasminogen activator tPA are time-dependent, and treatment for eligible patients should be initiated as quickly as possible even for patients who may also be candidates for mechanical thrombectomy.

IV tPA should be administered to all eligible acute stroke patients within 3 hours of last known normal and to a more selective group of eligible acute stroke patients based on ECASS III exclusion criteria within 4. Centers should attempt to achieve door-to-needle times of Prior to initiation of IV tPA in most patients, a noncontrast head computed tomography CT and glucose are the only required tests. An international normalized ratio, partial thromboplastin time, and platelet count do not need to have resulted prior to IV tPA initiation if there is no suspicion for underlying coagulopathy.

For patients who may be candidates for mechanical thrombectomy, an urgent CT angiogram or magnetic resonance MR angiogram to look for large vessel occlusion is recommended, but this study should not delay treatment with IV tPA if indicated.

In selected acute stroke patients within hours of last known normal who have evidence of a large vessel occlusion in the anterior circulation and would have been eligible for DAWN or DEFUSE 3, obtaining perfusion imaging CT-P or MR-P or an MRI with diffusion-weighted imaging DWI sequence is recommended to help determine whether the patient is a candidate for mechanical thrombectomy.

In selected acute stroke patients within hours of last known normal who have a large vessel occlusion in the anterior circulation and meet other DAWN or DEFUSE 3 eligibility criteria, mechanical thrombectomy is recommended. In selected acute stroke patients within hours of last known normal who have large vessel occlusion in the anterior circulation and meet other DAWN eligibility criteria, mechanical thrombectomy with a stent retriever is reasonable.

As with IV tPA, treatment with mechanical thrombectomy should be initiated as quickly as possible. Administration of aspirin is recommended in acute stroke patients within hours after stroke onset.

For patients treated with IV tPA, aspirin administration is generally delayed for 24 hours. Urgent anticoagulation e. The use of stroke units that incorporate rehabilitation is recommended for all acute stroke patients. It remains unknown whether it would be beneficial for emergency medical services to bypass a closer IV tPA-capable hospital for a thrombectomy-capable hospital. While such an approach may delay IV tPA administration for patients who are and who are not mechanical thrombectomy candidates, this approach would expedite thrombectomy for those who are mechanical thrombectomy candidates.

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