Τίτλος:
European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Intravenous thrombolysis is the only approved systemic reperfusion treatment for patients with acute ischaemic stroke. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions with regard to intravenous thrombolysis for acute ischaemic stroke. These guidelines were developed based on the ESO standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote recommendations. Expert consensus statements were provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found high quality evidence to recommend intravenous thrombolysis with alteplase to improve functional outcome in patients with acute ischemic stroke within 4.5 h after symptom onset. We also found high quality evidence to recommend intravenous thrombolysis with alteplase in patients with acute ischaemic stroke on awakening from sleep, who were last seen well more than 4.5 h earlier, who have MRI DWI-FLAIR mismatch, and for whom mechanical thrombectomy is not planned. These guidelines provide further recommendations regarding patient subgroups, late time windows, imaging selection strategies, relative and absolute contraindications to alteplase, and tenecteplase. Intravenous thrombolysis remains a cornerstone of acute stroke management. Appropriate patient selection and timely treatment are crucial. Further randomized controlled clinical trials are needed to inform clinical decision-making with regard to tenecteplase and the use of intravenous thrombolysis before mechanical thrombectomy in patients with large vessel occlusion. © European Stroke Organisation 2021.
Συγγραφείς:
Berge, E.
Whiteley, W.
Audebert, H.
Marchis, G.M.D.
Fonseca, A.C.
Padiglioni, C.
Ossa, N.P.D.L.
Strbian, D.
Tsivgoulis, G.
Turc, G.
Περιοδικό:
European Stroke Journal
Εκδότης:
SAGE Publications Ltd
Λέξεις-κλειδιά:
alteplase; tenecteplase, acute ischemic stroke; Article; blood clot lysis; blood vessel occlusion; brain hemorrhage; cerebrovascular accident; clinical decision making; computer assisted tomography; diffusion weighted imaging; echo planar imaging; European Stroke Organisation; fluid-attenuated inversion recovery imaging; follow up; health care organization; health care system; human; mechanical thrombectomy; meta analysis; nuclear magnetic resonance imaging; outcome assessment; practice guideline; quality of life; randomized controlled trial (topic); Rankin scale; risk assessment; systematic review
DOI:
10.1177/2396987321989865
