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AHA Stroke Council Updates Acute Stroke Guidelines

Tissue plasminogen activator remains the most effective treatment

MONDAY, April 16 (HealthDay News) -- Intravenous administration of recombinant tissue plasminogen activator (tPA) remains the most effective treatment for acute ischemic stroke, while newer options such as intra-arterial administration of thrombolytic agents and mechanical removal of blood clots show promise, according to a panel appointed by the American Heart Association Stroke Council. The panel's updated guidelines were published online April 12 in the journal Stroke.

The panel reviewed the medical literature with an emphasis on reports published since 2003. The recommendations are an extensive update of those published in 2003 and 2005.

"Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials," concluded the committee chaired by Harold P. Adams Jr., M.D., from the University of Iowa in Iowa City. "This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital."

The guidelines note that tPA should be used within three hours of symptom onset, while the newer treatments may be useful for patients with moderate-to-severe strokes who arrive at the hospital too late to receive tPA.

Hospitals should develop emergency stroke protocols to treat patients within an hour of arrival and should consider seeking certification as primary or comprehensive stroke centers. Patients should also be treated for conditions that can adversely affect stroke outcome such as high blood pressure, fever, or high blood sugar. Drugs other than tPA should only be given as part of a clinical trial.

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