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What You Need to Know About Stroke
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Stroke: Challenges, Progress, and Promise
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Clinical Practice Guidelines for Stroke
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
Guidelines for the Management of Spontaneous Intracerebral Hemorrhage
Guidelines for Adult Stroke Rehabilitation and Recovery
Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient
Benefits of tPA for Stroke Extended to 9 Hours Post Onset
Like mechanical revascularization, IV thrombolysis with a pharmacologic agent can help preserve the functional capabilities of patients even 4.5 to 9 hours after stroke onset -- provided they still have salvageable brain tissue, published data from the EXTEND trial showed.
People who presented late but with imaging results showing relatively small infarct cores still had better odds of good functional outcomes after getting alteplase, as 35.4% of this group scored a 0 or a 1 on the modified Rankin scale (mRS) at 90 days, compared with 29.5% of the placebo arm (adjusted RR 1.44, 95% CI 1.01-2.06), reported Geoffrey Donnan, MD, of Royal Melbourne Hospital, and colleagues in the New England Journal of
Medicine. The trial randomized 225 stroke patients who had arrived at the hospital later than the first 4.5 hours after symptom onset or after waking up with a stroke. They were imaged with CT perfusion imaging and perfusion-diffusion MRI.
Yet a secondary ordinal analysis of the distribution of mRS scores did not show better functional improvement at 90 days with late thrombolysis, according to the full New England Journal paper, which also came with an accompanying editorial.
In addition, the risk of symptomatic intracerebral hemorrhage was increased with alteplase (6.2% vs 0.9%, adjusted RR 7.22, 95% CI 0.97-53.5).
"The authors are to be commended for a groundbreaking trial. It suggests, for the first time, that the benefit of alteplase may persist after more than 4.5 hours of symptoms in selected patients," Pooja Khatri, MD, MSc, of the University of Cincinnati, told MedPage Today.