2018 Stroke Guidelines from Sun Yai-Cheng

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

• AIS < 6 hr (Class I)
• AIS < 6-16 hr: DAWN or DEFUSE 3 criteria (Class I)
• AIS < 6-24 hr: DAWN criteria (Class IIa)

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)