Acute ischemic stroke: AHA/ASA guidelines for early management are updated

  • Powers WJ & al.
  • Stroke
  • 30 Oct 2019

  • International Clinical Digest
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Takeaway

  • The American Heart Association and American Stroke Association have updated guidelines for the early management of acute ischemic stroke in adults.

Why this matters

  • There have been newly published randomized controlled trials since the guidelines, first published in 2013, were last updated in January 2018.

Key results

  • Guideline sections:
    • Prehospital stroke management and systems of care.
    • Emergency evaluation and treatment.
    • General supportive care and emergency treatment.
    • In-hospital management pertaining to general supportive care.
    • In-hospital management pertaining to treatment of acute complications.
    • In-hospital institution of secondary stroke prevention.
  • Specific areas revised:
    • Section 3.5.6., Recommendation 1: BP should be maintained at
    • Class of recommendation: I.
    • Level of evidence: B-R.
  • Section 3.6., Recommendation 4: the use of sonothrombolysis as adjuvant therapy with intravenous fibrinolysis is not recommended:
    • Class of recommendation: III (no benefit).
    • Level of evidence: A.
  • Section 3.7.4., Recommendation 5: direct aspiration thrombectomy as first-pass mechanical thrombectomy is recommended as noninferior to stent retriever for patients who meet all 6 listed criteria:
    • Class of recommendation: I.
    • Level of evidence: B-R.
  • Updated guidelines are endorsed by the Society for Academic Emergency Medicine, Neurocritical Care Society.
  • Study design

    • Update of guidelines on management of arterial acute ischemic stroke in adults.
    • Process involved 19-member writing committee, 14 peer reviewers.
    • Consideration of new randomized controlled trials through April 2019.
    • Funding: None disclosed.

    Limitations

    • Persistent lack of data in some areas.
    • Uncertain generalizability.