Key Points ÎThis pocketcard covers three different stroke subpopulations:
> Patients with ischemic stroke or transient ischemic attacks (TIA) > Patients with intracerebral hemorrhage (ICH) > Patients with cerebral venous sinus thrombosis
Treatment
Acute Conditions Acute Ischemic Stroke Recombinant Tissue Plasminogen Activator
ÎIn patients with acute ischemic stroke in whom treatment can be initiated within 3 h of symptom onset, the American College of Chest Physicians (ACCP) recommends intravenous (IV) recombinant tissue plasminogen activator (r-tPA) over no IV r-tPA (1-A).
ÎIn patients with acute ischemic stroke in whom treatment can be initiated within 4.5 h but not within 3 h of symptom onset, the ACCP suggests IV r-tPA over no IV r-tPA (2-C).
ÎIn patients with acute ischemic stroke in whom treatment cannot be initiated within 4.5 h of symptom onset, the ACCP recommends AGAINST IV r-tPA (1-B).
ÎIn patients with acute ischemic stroke due to proximal cerebral artery occlusions who do not meet eligibility criteria for treatment with IV r-tPA, the ACCP suggests intraarterial (IA) r-tPA initiated within 6 h of symptom onset over no IA r-tPA (2-C).
ÎIn patients with acute ischemic stroke the ACCP suggests IV r-tPA over the combination IV/IA r-tPA (2-C).
Remark: Carefully selected patients who value the uncertain benefits of combination IV/IA thrombolysis higher than the associated risks may choose this intervention. Patients who prefer to avoid risk in the setting of uncertain benefits are more likely to choose IV r-tPA alone.
Restricted Mobility
ÎIn patients with acute ischemic stroke and restricted mobility, the ACCP suggests prophylactic dose subcutaneous heparin (unfractionated heparin [UFH] or low-molecular-weight heparin [LMWH]) or intermittent pneumatic compression devices (IPCDs) over no prophylaxis (2-B).
ÎIn patients with acute ischemic stroke and restricted mobility, the ACCP suggests prophylactic-dose LMWH over prophylactic-dose UFH (2-B).
