Treatment Guidelines & Recommendations - Part III

Symptomatic Hemorrhages by NIH Stroke Scale in NINDS Trial

Percentage of Patients that Developed Symptomatic Hemorrhages

Edema or Mass Effect Seen on Initial CT Source: Broderick, Stroke 1997

Percentage of rt-PA Patients with Symptomatic ICH

rt-PA Dosing

• 0.9 mg/kg (max = 90 mg)
• 10% bolus (over 1 minute)
• Remainder  as a 1 hour infusion
• Have rt-PA in the Emergency Department

Intra-arterial Thrombolytic Efficacy vs. Time of Delivery

Stroke Treatment – Aspirin

• Two important trials:
  • International Stroke Trial (IST)
  • Chinese Acute Stroke Trial (CAST)
• Combined analysis (n=40,090)
• Death / nonfatal strokes reduced 11%
• Don’t forget to check swallowing

Stroke Treatment – Heparinoids

• Two important trials:
  • International Stroke Trial (IST)
  • TOAST (Trial of ORG 10172)
• Decreased recurrent ischemic strokes
• Increased hemorrhagic events
• No net stroke benefit

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This presentation was written by Dr. Edward C. Jauch of the Greater Cincinnati / Northern Kentucky Stroke Team at the University of Cincinnati College of Medicine.

Last Revised: March 26, 2001