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Clinical Corner: New AHA Stroke Guidelines Part 1

by Joe Bryowsky RN, CCRN – Clinical Manager

On January 31, 2013 the American Heart Association announced the updated Guidelines for the Early management of Patients with Acute Ischemic Stroke.The new recommendations replace the guidelines last issued in 2007.

While some of the guidelines from 2007 remain the same other guidelines have been added, changed or eliminated.

The revised and new recommendations:

• Supports aggressive treatment of acute stroke with IV tPA (Tissue plasminogen activator)

• Shows evidence that patients benefit from the development of stroke systems of care. (EMS along with Acute Stroke Ready Hospitals, Primary Stroke Centers (PSC’s), and Comprehensive Stroke Centers (CSC’s)

• Recognizes that the addition of telemedicine
(telestroke) has further expanded the radius of stroke care delivery

• Recommends that EMS bypass hospitals that do not have resources to treat acute stroke

• Highlights pre-hospital notification by EMS

• Reiterates that only a limited number of laboratory and radiologic tests are required before administering IV tPA (blood glucose check and non-contrast enhanced CT or MRI)

• States that door to tPA bolus time interval of 60 minutes or less maximizes benefits of IV tPA

• Suggests that intra-arterial mechanical thrombectomy has emerged as a promising therapy for a subset of stroke patients that are identified with advanced neuroimaging

• States that tPA can now be considered for a larger group of patients, including some who present up to 4.5 hours from stroke onset

These guidelines also address the lack of clinical evidence in the following for the treatment of acute stroke:

• The use of devices to augment cerebral blood flow
• Drug induced hypertension
• Volume expansion
• Hypothermia

Continue reading part 2 of Clinical Corner: New AHA Stroke Guidelines

For more information regarding new stroke guidelines please visit: http://www.heart.org/HEARTORG/

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