2018年6月11日 星期一

2018 Stroke Guidelines



2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Stroke. 2018 Mar;49(3):e46-e110



2018 Stroke Guidelines

 

Class I

  • CT within 20 mins ≥50%
  • Door-to-needle time within 60 mins ≥50%
  • EVT, ECG, troponin should not delay IV t-PA
  • Only the assessment of blood glucose must precede the initiation of IV t-PA
  • Receive IV t-PA: BP < 185/110 mmHg
  • IV t-PA for AIS < 3 hr

    IV t-PA for AIS < 3 – 4.5 hr

    • for pts ≤ 80 y/o, without both DM and stroke hx, NIHSS ≤ 25, not taking any OACs, < 1/3 MCA territory by CT or MRI (Class I)
    • for pts > 80 y/o (Class IIa)
    • taking OACs and INR ≤ 1.7 and/or PT < 15 s (Class IIb)
    • with both DM and stroke hx (Class IIb)

      Endovascular Therapy



          2018 Acute Stroke Guidelines 重要更新摘要

          • 對於 3 – 4.5 小時 的中風,年紀大於80歲 (Class IIa),服用抗凝血劑且 INR ≤ 1.7 and/or PT < 15 秒 (Class IIb),同時有糖尿病和中風病史 (Class IIb),IV t-PA 不再是禁忌症。
          • Endovascular Therapy 適應症 延長至 6 – 24小時。中風 6 –16小時 需符合 DAWN or DEFUSE 3 criteria (Class I);中風 6–24 小時 需符合 DAWN criteria (Class IIa)

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