(Australian) Clinical Guidelines for Stroke Management - Chapter 3 of 8: Acute medical and surgical management

Main Editor Stroke Foundation
Language en
Last Update Sep 16, 2019
Published Date Sep 16, 2019
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Disclaimer

These Clinical Guidelines are a general guide to appropriate practice, to be followed subject to the clinician’s judgment and the patient’s preference in each individual case. The Clinical Guidelines are designed to provide information to assist decision-making and are based on the best evidence available at the time of development. The Clinical Guidelines can be viewed at www.informme.org.au - Citation: Stroke Foundation. Clinical Guidelines for Stroke Management. Melbourne Australia. © No part of this publication can be reproduced by any process without permission from the Stroke Foundation. August 2019.

Sponsors The Stroke Foundation gratefully acknowledges the financial assistance provided by the Australian Government via the Medical Research Future Fund. The development of the final recommendations has not been influenced by the views or interests of the funding body.
Abstract

This is the third in a series of eight guideline chapters that provide evidence-based recommendations for recovery from stroke and TIA.

PICOS
PICO 5.0
P: Adults with stroke
I: Organised stroke unit care
C: Alternative services (less organised care)
O:

PICO 7.0
P: Adults with stroke
I: Interdisciplinary palliative care
C: Usual care
O:

PICO 2.0
P: Adults with stroke
I: Endovascular mechanical thrombectomy
C: Standard medical care
O:

PICO 9.0
P: Adults with stroke
I: Early swallow screen
C: Usual care
O:

PICO 10.0
P: Adults with acute ischaemic stroke
I: Aspirin
C: Placebo or no treatment
O:

PICO 11.0
P: Adults with ICH
I: Blood pressure lowering
C: Control
O:

PICO 12.0
P: Adults > 60 y.o. with malignant middle cerebral artery infarct
I: Hemicraniectomy
C: Medical treatment
O:

PICO 1.0
P: Adults with intracerebral haemorrhage
I: Edaravone
C: Usual care
O:

PICO 2.0
P: Patients with Basal ganglia/thalamic haematomas
I: Surgery
C: Conservative treatment
O:

PICO 14.0
P: Adults with acute ischaemic stroke
I: Early routine oxygen supplementation
C: Room air
O:

PICO 16.0
P: Adults with stroke
I: Fever, Sugar, Swallow (FeSS) protocol
C: No FeSS protocol
O:

PICO 17.0
P: Adults with stroke
I: FeSS protocol (Fever, Sugar, Swallow)
C: No FeSS protocol
O:

PICO 5.0
P: Adults with stroke
I: Organised stroke unit care
C: General medical wards
O:

PICO 2.0
P: Adults with stroke
I: Endovascular mechanical thrombectomy + intravenous thrombolysis
C: Intravenous thrombolysis alone
O:

PICO 9.0
P: Adults with stroke
I: Swallow screen test
C: Reference standard (FEES or VF)
O:

PICO 10.0
P: Adults with acute ischaemic stroke
I: Anticoagulant
C: Placebo or no treatment
O:

PICO 11.0
P: Adults with ischaemic stroke
I: Blood pressure lowering
C: Control
O:

PICO 12.0
P: Adults < 60 y.o. with malignant middle cerebral artery infarct
I: Hemicraniectomy
C: Medical treatment
O:

PICO 1.0
P: Adults with intracerebral haemorrhage
I: Cerebrolysin
C: Placebo
O:

PICO 2.0
P: Patients with lobar haematoma
I: Surgery
C: Conservative treatment
O:

PICO 14.0
P: Adults with acute ischaemic stroke
I: Hyperbaric oxygen therapy
C: Standard practice
O:

PICO 16.0
P: Adults with stroke with hyperglycaemia
I: Intravenous insulin
C: Subcutaneous insulin
O:

PICO 17.0
P: Adults with stroke
I: Therapeutic hypothermia
C: Standardized stroke unit care
O:

PICO 5.0
P: Adults with stroke
I: Different systems of organised care: acute stroke ward
C: Alternative service
O:

PICO 2.0
P: Adults with stroke
I: Stent retrievers
C: Merci device
O:

PICO 9.0
P: Adults with stroke
I: Clinical bedside swallow exam
C: Instrumental swallow exam
O:

PICO 10.0
P: Adults with acute stroke
I: Dual antiplatelet therapy
C: Mono antiplatelet therapy
O:

PICO 11.0
P: Adults with stroke
I: Continue pre-stroke antihypertensives
C: Stop pre-stroke antihypertensives
O:

PICO 12.0
P: Adults with malignant middle cerebral artery infarct
I: Hemicraniectomy
C: Medical Management
O:

PICO 1.0
P: Adults with intracerebral haemorrhage
I: Tranexamic Acid
C: Placebo
O:

PICO 2.0
P: Adults with intraventricular haemorrhage complicating parenchymal haemorrhage
I: Surgery
C: Conservative treatment
O:

PICO 16.0
P: Adults with stroke with hyperglycaemia
I: Intravenous insulin
C: Normal saline
O:

PICO 17.0
P: Adults with stroke
I: Paracetamol
C: Placebo
O:

PICO 5.0
P: Adults with stroke
I: Different systems of organised care: comprehensive stroke ward
C: Alternative service (mobile stroke team)
O:

PICO 2.0
P: Adults with stroke ineligible for IV thrombolysis
I: Endovascular mechanical thrombectomy
C: Standard care
O:

PICO 9.0
P: All stroke patients with dysphagia
I: Surface neuromuscular electrical stimulation plus swallow therapy
C: Swallow therapy only
O:

PICO 10.0
P: Adult stroke patients treated with alteplase
I: Early antiplatelet therapy
C: No additional therapy
O:

PICO 12.0
P: Corticosteroids for acute ischaemic stroke
I: Corticosteroids
C: Placebo
O:

PICO 1.0
P: Adults with intracranial haemorrhage related to vitamin K antagonists
I: Prothrombin complex concentrate
C: Fresh frozen plasma
O:

PICO 2.0
P: Adults with intraventricular haemorrhage complicating parenchymal haemorrhage
I: Intraventricular thrombolysis
C: Placebo
O:

PICO 16.0
P: Adults with stroke
I: Insulin for glycaemic control
C: Usual care
O:

PICO 5.0
P: Organised inpatient (stroke unit) care for stroke
I: Different systems of organised care: rehabilitation stroke ward
C: Alternative service (mixed rehabilitation ward)
O:

PICO 2.0
P: Adults with stroke onset > 6 hours
I: Endovascular mechanical thrombectomy
C: Standard care
O:

PICO 9.0
P: All stroke patients with dysphagia
I: Pharyngeal electrical stimulation
C: Sham
O:

PICO 1.0
P: Adults with intracerebral haemorrhage taking antiplatelet before
I: Platelet transfusion
C: Standard care
O:

PICO 5.0
P: Continuous versus intermittent physiological monitoring for acute stroke
I: Continuous monitoring
C: Intermittent monitoring of physiological variables
O:

PICO 2.0
P: Adults with stroke aged over 80 years
I: Endovascular mechanical thrombectomy
C: Standard medical care
O:

PICO 9.0
P: All stroke patients with dysphagia
I: Brain stimulation
C: Sham
O:

PICO 1.0
P: Adults with ICH related with DOACs
I: Reversal agents
C: No treatment
O:

PICO 5.0
P: Adults with stroke
I: Acute nursing intervention
C: Control
O:

PICO 2.0
P: Adults with stroke caused by distal MCA (M2) occlusion
I: Endovascular mechanical thrombectomy
C: Standard medical care
O:

PICO 9.0
P: All stroke patients with dysphagia
I: Acupuncture
C: No acupuncture
O:

PICO 2.0
P: Adults with basilar artery occlusion
I: Endovascular mechanical thrombectomy
C: Control
O:

PICO 9.0
P: All stroke patients with dysphagia
I: Behavioural intervention
C: Control
O:

PICO 1.1
P: Adults with acute stroke treated within 6 hours without perfusion imaging selection
I: Intravenous alteplase
C: Control
O:

PICO 1.2
P: Adults with acute stroke treated within 3 hours without perfusion imaging selection
I: Intravenous alteplase
C: Control
O:

PICO 1.3
P: Adults with acute stroke treated at 3-4.5 hours without perfusion imaging selection
I: Intravenous alteplase
C: Control
O:

PICO 1.4
P: Adults with acute stroke treated at 4.5-6 hours without perfusion imaging selection
I: Intravenous alteplase
C: Control
O:

PICO 1.5
P: Adults with acute stroke treated 4.5-9 hours or after wake-up onset using perfusion imaging selection
I: Intravenous alteplase
C: Control
O:

PICO 1.6
P: Adults with acute stroke
I: Low-dose intravenous alteplase
C: Standard-dose intravenous alteplase
O:

PICO 1.7
P: Adults with acute stroke
I: Sonothrombolysis
C: Alteplase only
O:

PICO 1.8
P: Adults with acute stroke due to large vessel occlusion treated at 0-4.5 hours without perfusion imaging selection
I: Intravenous tenecteplase
C: Intravenous alteplase
O:

PICO 1.9
P: Adults with acute stroke treated within 4.5 hours
I: Intravenous tenecteplase
C: Intravenous alteplase
O:

PICO 1.10
P: Adults with acute stroke of uncertain onset time treated on the basis of MRI diffusion-FLAIR mismatch
I: Intravenous Alteplase
C: Control
O: