Ischaemic stroke – acute phase therapy
Keywords:
stroke, fibrinolytics, anti-platelet aggregants, anticoagulants, stroke unit, acute therapyAbstract
The author describes the current therapy of
acute ischaemic stroke, highlighting anti-platelet aggregation, anticoagulants and fibrinolytics.
The importance of a Stroke Unit is emphasised
as well as the relevance of temperature, glucose
and blood pressure control. Finally, the imaging methods necessary for diagnosis and the
relationship between imaging and fibrinolytic
therapy is described. The role of the Internist
in the application of this complex therapeutic approach is discussed.
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References
International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke. The Lancet 1997; 349: 1569-1581.
BM Coull, L S Williams, LB Goldstein et al. Anticoagulants and antiplatelet agents in Acute Ischemic Stroke – Report of the Joint
Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association. STROKE 2002;
: 1934-1942.
Richard Kay, KA Sing Wong, Yuk Ling Yu et al. Low-molecular-weight heparin for the treatment of acute ischemic stroke. The New England
Journal of Medicine 1995; 333: 1588-1593.
The National Institute of Neurological Disorders and Stroke rT-PA Stroke Study Group. Tissue Plasminogen Activator for Acute Ischemic
Stroke. The New England Journal of Medicine 1995; 333: 1581-1587.
Hacke W, Kaste M, Fieschi C et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke.
The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274(13): 1017-1025.
Steiner T, Bluhmki E, Kaste M et al. The ECASS 3-hour cohort. Secondary analysis of ECASS data by time stratification. ECASS Study
Group. European Cooperative Acute Stroke Study. Cerebrovascular Diseases 1998;8(4): 198-203.
Werner Hacke, Markku Kaste, Cesare Fieschi et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). The Lancet 1998; 352(9136): 1245-1251.
Clark W M, Wissman S, Albers G W et al. Recombinant tissue-plasminogen activator (Alteplase) for ischemic Stroke 3 to 5 hours after
symptoms onset. The ATLANTIS Study: a randomised controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in
Ischemic Stroke. JAMA 1999; 282(21): 2019-2026.
Gregory W Albers, Wayne M Clark, Kenneth P Madden et al. ATLANTIS trial - Results for patients treated within 3 hours of stroke onset.
STROKE 2002; 33: 493-496.
Henrik S Jorgensen, Hirofumi Nakayma, Hans O Raaschou et al. The effect of a stroke unit: Reductions in mortality discharge rate to
nursing home length of hospital stay and cost. STROKE 1995; 26: 1178-1182.
L P Kammersgaard, HS Jorgensen, JA Rungby et al. Admission body temperature predicts long-term mortality after acute stroke. The Copenhagen Stroke Study. STROKE 2002; 33: 1759.
C M Burchfiel, JD Curb, BL Rodriguez et al. Glucose intolerance and 22-year stroke incidence. The Honolulu Heart Program. STROKE
; 25: 951-957.
S Goya Wannamethee, Ivan J Perry, A Gerald Shaper. Nonfasting serum glucose and insulin concentrations and the risk of stroke. STROKE
; 30: 1780-1786.
Andrew M Demchuk, Lewis B Morgenstern, Derk W Krieger et al. Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke. STROKE 1999; 30: 34-39.
A Bruno, SR Levine, M R Frankel et al. Admission glucose level and clinical outcomes in the NINDS rT-Pa stroke trial. Neurology 2002;
: 669-674.
P A Barber, DG Darby, PM Desmond et al. Identification of major ischemic change. Diffusion-weighted imaging versus computed tomography. STROKE 1999; 30: 2059-2065.
Magdy Selim, John N Fink, Sandeep Kumar et al. Predictors of hemorrhagic transformation after intravenous recombinant tissue plasminogen activator. STROKE 2002; 33: 2047-2052.
Juan F Arenillas, Álex Rovira, Carlos A Molina et al. Prediction of early neurological deterioration using difusion and perfusion-weighted
imaging in hyperacute middle cerebral artery ischemic stroke. STROKE 2002; 33: 2197-2203.
J B Fiebach, PD Schellinger, O Jansen et al. CT and Diffusion-Weighted MR imaging in randomised order – Diffusion-Weighted Imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. STROKE 2002; 33: 2206-2210.
Turgut Tatlisumak. With Acute Stroke? Why should men divide if fate has united. STROKE 2002: 33: 2144-2145
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