Australian and New Zealand Living Clinical Guidelines for Stroke Management - Chapter 3 of 8: Acute medical and surgical management

Published by Stroke Foundation on Jul 28, 2023

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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 Guideline is 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. June 2022.

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

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Abstract

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

Language

en-au

PICOS

PICO 10.1

Population
Corticosteroids for acute ischaemic stroke
Intervention
Corticosteroids
Comparator
Placebo
Outcomes

PICO 10.1

Population
Adults with intracerebral haemorrhage
Intervention
Edaravone
Comparator
Usual care
Outcomes

PICO 10.1

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

PICO 10.2

Population
Adults with intracerebral haemorrhage
Intervention
Cerebrolysin
Comparator
Placebo
Outcomes

PICO 10.2

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

PICO 10.3

Population
Adults with intracerebral haemorrhage
Intervention
Haemostatic agents
Comparator
Placebo
Outcomes

PICO 10.3

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

PICO 10.4

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

PICO 10.4

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

PICO 10.5

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 10.5

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

PICO 10.6

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

PICO 10.6

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

PICO 10.7

Population
Adults with acute stroke
Intervention
Sonothrombolysis
Comparator
Alteplase only
Outcomes

PICO 10.8

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 10.9

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

PICO 10.10

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 10.11

Population
Adults with basilar artery occlusion
Intervention
Intravenous alteplase
Comparator
Control
Outcomes

PICO 20.1

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

PICO 20.1

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

PICO 20.2

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

PICO 20.2

Population
Patients with lobar haematoma
Intervention
Surgery
Comparator
Conservative treatment
Outcomes

PICO 20.3

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

PICO 20.3

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

PICO 20.4

Population
Adults with stroke
Intervention
Stent retrievers
Comparator
Merci device
Outcomes

PICO 20.4

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

PICO 20.5

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

PICO 20.6

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

PICO 20.7

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

PICO 20.8

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

PICO 20.9

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

PICO 20.10

Population
Adults with stroke caused by intracranial atherosclerotic stenosis (ICAS)
Intervention
Endovascular thrombectomy
Comparator
Standard medical care
Outcomes

PICO 20.11

Population
Adults with large ischemic region stroke (ASPECTS 3-5)
Intervention
Endovascular mechanical thrombectomy + intravenous thrombolysis
Comparator
Medical treatment
Outcomes

PICO 20.12

Population
Adults with venous sinus thrombosis
Intervention
Endovascular treatment with medical management
Comparator
Standard care
Outcomes

PICO 50.1

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

PICO 50.2

Population
Adults with stroke
Intervention
stroke unit ward
Comparator
General medical wards
Outcomes

PICO 50.3

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

PICO 50.4

Population
Adults with stroke
Intervention
Acute nursing intervention
Comparator
Control
Outcomes

PICO 70.1

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

PICO 90.1

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

PICO 90.2

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

PICO 90.3

Population
Adults with stroke
Intervention
Clinical swallowing evaluation
Comparator
Instrumental swallow exam
Outcomes

PICO 90.4

Population
All stroke patients with dysphagia
Intervention
Postural techniques and swallow strategies (compensatory -direct)
Comparator
Control
Outcomes

PICO 90.5

Population
All stroke patients with dysphagia
Intervention
Modification of food and fluid consistencies (compensatory -direct)
Comparator
Control
Outcomes

PICO 90.6

Population
All stroke patients with dysphagia
Intervention
Surface neuromuscular electrical stimulation
Comparator
Usual care / placebo / sham
Outcomes

PICO 90.7

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

PICO 90.8

Population
All stroke patients with dysphagia
Intervention
Transcranial direct current stimulation
Comparator
Sham or control
Outcomes

PICO 90.9

Population
All stroke patients with dysphagia
Intervention
Transcranial magnetic stimulation
Comparator
Sham or control
Outcomes

PICO 90.10

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

PICO 90.11

Population
All stroke patients with dysphagia
Intervention
Rehabilitative exercises (rehabilitation -indirect)
Comparator
Control
Outcomes

PICO 90.12

Population
All stroke patients with dysphagia
Intervention
Peripheral sensory stimulation (rehabilitation -indirect)
Comparator
Control
Outcomes

PICO 90.13

Population
All stroke patients with dysphagia
Intervention
Drug therapy
Comparator
Control
Outcomes

PICO 90.14

Population
All stroke patients with dysphagia
Intervention
Biofeedback as adjunctive
Comparator
Control
Outcomes

PICO 100.1

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

PICO 100.2

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

PICO 100.3

Population
Adults with acute stroke
Intervention
Clopidegrol and aspirin
Comparator
Aspirin
Outcomes

PICO 100.4

Population
Adults with acute stroke
Intervention
Ticagrelor and aspirin
Comparator
Aspirin
Outcomes

PICO 100.5

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

PICO 110.1

Population
Adults with ICH
Intervention
Blood pressure lowering
Comparator
Control
Outcomes

PICO 110.2

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

PICO 110.3

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

PICO 120.1

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

PICO 120.2

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

PICO 140.1

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

PICO 140.2

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

PICO 150.1

Population
Patients with acute ischaemic stroke (AIS)
Intervention
Magnesium Sulphate
Comparator
Placebo
Outcomes

PICO 150.2

Population
Patients with acute ischaemic stroke (AIS)
Intervention
Minocycline
Comparator
Placebo
Outcomes

PICO 150.3

Population
Patients with ischaemic stroke
Intervention
Any neuroprotective agents
Comparator
Placebo
Outcomes

PICO 160.1

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

PICO 160.2

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

PICO 170.1

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

PICO 170.2

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

PICO 170.3

Population
Adults with stroke
Intervention
Paracetamol
Comparator
Placebo
Outcomes

PICO 180.1

Population
People with suspected acute stroke
Intervention
Integrated telestroke program
Comparator
Usual care
Outcomes

PICO 180.2

Population
Adults with acute or suspected stroke
Intervention
Acute telestroke connections using video conference
Comparator
Telestroke using telephone contact alone
Outcomes

PICO 190.1

Population
Adults with stroke
Intervention
Supine positioning
Comparator
Sitting up
Outcomes