Acute Ischemic Stroke

Acute Ischemic Stroke - Early Management

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ÎÎIn patients with mild stroke deficits, rapidly improving stroke symptoms, major surgery in the preceding 3 months, and recent myocardial infarction, consider use of IV fibrinolysis and weigh potential increased risk against the anticipated benefits (IIb-C). Note: These circumstances require further study. ÎÎThe IV administration of streptokinase for treatment of stroke is NOT recommended (III-A). ÎÎThe use of IV rtPA in patients taking direct thrombin inhibitors or direct factor Xa inhibitors may be harmful and is NOT recommended unless sensitive laboratory tests such as activated partial thromboplastin time (aPTT), international normalized ratio (INR), platelet count, and ecarin clotting time (ECT), thrombin time (TT), or appropriate direct factor Xa activity assays are normal, or the patient has not received a dose of these agents for >2 days (assuming normal renal metabolizing function). Similar consideration should be given to patients being considered for intra-arterial rtPA (III-C). 15

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