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

Published by Stroke Foundation on Nov 8, 2019

View

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.

Contact

Abstract

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

Language

en

PICOS

PICO 1.0

Population
Adults with intracerebral haemorrhage
Intervention
Edaravone
Comparator
Usual care
Outcomes

PICO 1.0

Population
Adults with intracerebral haemorrhage
Intervention
Cerebrolysin
Comparator
Placebo
Outcomes

PICO 1.0

Population
Adults with intracerebral haemorrhage
Intervention
Tranexamic Acid
Comparator
Placebo
Outcomes

PICO 1.0

Population
Adults with intracranial haemorrhage related to vitamin K antagonists
Intervention
Prothrombin complex concentrate
Comparator
Fresh frozen plasma
Outcomes

PICO 1.0

Population
Adults with intracerebral haemorrhage taking antiplatelet before
Intervention
Platelet transfusion
Comparator
Standard care
Outcomes

PICO 1.0

Population
Adults with ICH related with DOACs
Intervention
Reversal agents
Comparator
No treatment
Outcomes

PICO 1.1

Population
Adults with acute stroke treated within 6 hours without perfusion imaging selection
Intervention
Intravenous alteplase
Comparator
Control
Outcomes

PICO 1.2

Population
Adults with acute stroke treated within 3 hours without perfusion imaging selection
Intervention
Intravenous alteplase
Comparator
Control
Outcomes

PICO 1.3

Population
Adults with acute stroke treated at 3-4.5 hours without perfusion imaging selection
Intervention
Intravenous alteplase
Comparator
Control
Outcomes

PICO 1.4

Population
Adults with acute stroke treated at 4.5-6 hours without perfusion imaging selection
Intervention
Intravenous alteplase
Comparator
Control
Outcomes

PICO 1.5

Population
Adults with acute stroke treated 4.5-9 hours or after wake-up onset using perfusion imaging selection
Intervention
Intravenous alteplase
Comparator
Control
Outcomes

PICO 1.6

Population
Adults with acute stroke
Intervention
Low-dose intravenous alteplase
Comparator
Standard-dose intravenous alteplase
Outcomes

PICO 1.7

Population
Adults with acute stroke
Intervention
Sonothrombolysis
Comparator
Alteplase only
Outcomes

PICO 1.8

Population
Adults with acute stroke due to large vessel occlusion treated at 0-4.5 hours without perfusion imaging selection
Intervention
Intravenous tenecteplase
Comparator
Intravenous alteplase
Outcomes

PICO 1.9

Population
Adults with acute stroke treated within 4.5 hours
Intervention
Intravenous tenecteplase
Comparator
Intravenous alteplase
Outcomes

PICO 1.10

Population
Adults with acute stroke of uncertain onset time treated on the basis of MRI diffusion-FLAIR mismatch
Intervention
Intravenous Alteplase
Comparator
Control
Outcomes

PICO 2.0

Population
Adults with stroke
Intervention
Endovascular mechanical thrombectomy
Comparator
Standard medical care
Outcomes

PICO 2.0

Population
Patients with Basal ganglia/thalamic haematomas
Intervention
Surgery
Comparator
Conservative treatment
Outcomes

PICO 2.0

Population
Adults with stroke
Intervention
Endovascular mechanical thrombectomy + intravenous thrombolysis
Comparator
Intravenous thrombolysis alone
Outcomes

PICO 2.0

Population
Patients with lobar haematoma
Intervention
Surgery
Comparator
Conservative treatment
Outcomes

PICO 2.0

Population
Adults with stroke
Intervention
Stent retrievers
Comparator
Merci device
Outcomes

PICO 2.0

Population
Adults with intraventricular haemorrhage complicating parenchymal haemorrhage
Intervention
Surgery
Comparator
Conservative treatment
Outcomes

PICO 2.0

Population
Adults with stroke ineligible for IV thrombolysis
Intervention
Endovascular mechanical thrombectomy
Comparator
Standard care
Outcomes

PICO 2.0

Population
Adults with intraventricular haemorrhage complicating parenchymal haemorrhage
Intervention
Intraventricular thrombolysis
Comparator
Placebo
Outcomes

PICO 2.0

Population
Adults with stroke onset > 6 hours
Intervention
Endovascular mechanical thrombectomy
Comparator
Standard care
Outcomes

PICO 2.0

Population
Adults with stroke aged over 80 years
Intervention
Endovascular mechanical thrombectomy
Comparator
Standard medical care
Outcomes

PICO 2.0

Population
Adults with stroke caused by distal MCA (M2) occlusion
Intervention
Endovascular mechanical thrombectomy
Comparator
Standard medical care
Outcomes

PICO 2.0

Population
Adults with basilar artery occlusion
Intervention
Endovascular mechanical thrombectomy
Comparator
Control
Outcomes

PICO 5.0

Population
Adults with stroke
Intervention
Organised stroke unit care
Comparator
Alternative services (less organised care)
Outcomes

PICO 5.0

Population
Adults with stroke
Intervention
Organised stroke unit care
Comparator
General medical wards
Outcomes

PICO 5.0

Population
Adults with stroke
Intervention
Different systems of organised care: acute stroke ward
Comparator
Alternative service
Outcomes

PICO 5.0

Population
Adults with stroke
Intervention
Different systems of organised care: comprehensive stroke ward
Comparator
Alternative service (mobile stroke team)
Outcomes

PICO 5.0

Population
Organised inpatient (stroke unit) care for stroke
Intervention
Different systems of organised care: rehabilitation stroke ward
Comparator
Alternative service (mixed rehabilitation ward)
Outcomes

PICO 5.0

Population
Continuous versus intermittent physiological monitoring for acute stroke
Intervention
Continuous monitoring
Comparator
Intermittent monitoring of physiological variables
Outcomes

PICO 5.0

Population
Adults with stroke
Intervention
Acute nursing intervention
Comparator
Control
Outcomes

PICO 7.0

Population
Adults with stroke
Intervention
Interdisciplinary palliative care
Comparator
Usual care
Outcomes

PICO 9.0

Population
Adults with stroke
Intervention
Early swallow screen
Comparator
Usual care
Outcomes

PICO 9.0

Population
Adults with stroke
Intervention
Swallow screen test
Comparator
Reference standard (FEES or VF)
Outcomes

PICO 9.0

Population
Adults with stroke
Intervention
Clinical bedside swallow exam
Comparator
Instrumental swallow exam
Outcomes

PICO 9.0

Population
All stroke patients with dysphagia
Intervention
Surface neuromuscular electrical stimulation plus swallow therapy
Comparator
Swallow therapy only
Outcomes

PICO 9.0

Population
All stroke patients with dysphagia
Intervention
Pharyngeal electrical stimulation
Comparator
Sham
Outcomes

PICO 9.0

Population
All stroke patients with dysphagia
Intervention
Brain stimulation
Comparator
Sham
Outcomes

PICO 9.0

Population
All stroke patients with dysphagia
Intervention
Acupuncture
Comparator
No acupuncture
Outcomes

PICO 9.0

Population
All stroke patients with dysphagia
Intervention
Behavioural intervention
Comparator
Control
Outcomes

PICO 10.0

Population
Adults with acute ischaemic stroke
Intervention
Aspirin
Comparator
Placebo or no treatment
Outcomes

PICO 10.0

Population
Adults with acute ischaemic stroke
Intervention
Anticoagulant
Comparator
Placebo or no treatment
Outcomes

PICO 10.0

Population
Adults with acute stroke
Intervention
Dual antiplatelet therapy
Comparator
Mono antiplatelet therapy
Outcomes

PICO 10.0

Population
Adult stroke patients treated with alteplase
Intervention
Early antiplatelet therapy
Comparator
No additional therapy
Outcomes

PICO 11.0

Population
Adults with ICH
Intervention
Blood pressure lowering
Comparator
Control
Outcomes

PICO 11.0

Population
Adults with ischaemic stroke
Intervention
Blood pressure lowering
Comparator
Control
Outcomes

PICO 11.0

Population
Adults with stroke
Intervention
Continue pre-stroke antihypertensives
Comparator
Stop pre-stroke antihypertensives
Outcomes

PICO 12.0

Population
Adults > 60 y.o. with malignant middle cerebral artery infarct
Intervention
Hemicraniectomy
Comparator
Medical treatment
Outcomes

PICO 12.0

Population
Adults < 60 y.o. with malignant middle cerebral artery infarct
Intervention
Hemicraniectomy
Comparator
Medical treatment
Outcomes

PICO 12.0

Population
Adults with malignant middle cerebral artery infarct
Intervention
Hemicraniectomy
Comparator
Medical Management
Outcomes

PICO 12.0

Population
Corticosteroids for acute ischaemic stroke
Intervention
Corticosteroids
Comparator
Placebo
Outcomes

PICO 14.0

Population
Adults with acute ischaemic stroke
Intervention
Early routine oxygen supplementation
Comparator
Room air
Outcomes

PICO 14.0

Population
Adults with acute ischaemic stroke
Intervention
Hyperbaric oxygen therapy
Comparator
Standard practice
Outcomes

PICO 16.0

Population
Adults with stroke
Intervention
Fever, Sugar, Swallow (FeSS) protocol
Comparator
No FeSS protocol
Outcomes

PICO 16.0

Population
Adults with stroke with hyperglycaemia
Intervention
Intravenous insulin
Comparator
Subcutaneous insulin
Outcomes

PICO 16.0

Population
Adults with stroke with hyperglycaemia
Intervention
Intravenous insulin
Comparator
Normal saline
Outcomes

PICO 16.0

Population
Adults with stroke
Intervention
Insulin for glycaemic control
Comparator
Usual care
Outcomes

PICO 17.0

Population
Adults with stroke
Intervention
FeSS protocol (Fever, Sugar, Swallow)
Comparator
No FeSS protocol
Outcomes

PICO 17.0

Population
Adults with stroke
Intervention
Therapeutic hypothermia
Comparator
Standardized stroke unit care
Outcomes

PICO 17.0

Population
Adults with stroke
Intervention
Paracetamol
Comparator
Placebo
Outcomes