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Parenteral agents such as labetalol that are easily titrated and that have minimal vasodilator effects on cerebral blood vessels are preferred. When treatment is indicated, lowering the blood pressure should be done cautiously to minimize the chance of relative hypotension.
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The consensus is that antihypertensive agents should be withheld unless the diastolic blood pressure is above 120 mmHg or unless the systolic blood pressure is above 220 mmHg ( Table 1). Although severe hypertension is a contraindication for thrombolytic therapy, there are no data to define the levels of arterial hypertension that mandate emergent management. In the setting of AIS, many patients will have elevated blood pressure for the first 24–48 hours. Third, acute medical or neurologic complications of stroke must be anticipated.įinally, the most likely pathophysiology and etiology is considered and treatment is directed towards preventing recurrent ischemic events. Second, the advisability for acute treatment with thrombolytic agents and endovascular device therapies must be considered, and general supportive care must be administered. The first goal of the evaluation of a suspected ischemic stroke is to exclude intracranial hemorrhage with neuro-imaging. This approach consists of four main goals: We discuss the medications related to ischemic stroke care in the context of the overall treatment approach towards the patient. Ischemic stroke, or disruption of blood flow to the brain, accounts for about 85 % of all strokes. Every year, about 795,000 new or recurrent strokes occur, which cost an estimated US$73.7 billion in 2010 alone. Stroke is the fourth leading cause of death and the leading cause of disability in the elderly in the USA. Ongoing clinical trials may lead to further medical breakthroughs to limit the damage inflicted by this devastating disease. The majority of AIS patients do not receive thrombolytic therapy due to late arrival to emergency departments and currently there is a paucity of acute interventions for them. Urgent antiplatelet use for AIS has limited benefits and should only promptly be initiated if alteplase was not administered, or after 24 hours if alteplase was administered. Urgent anticoagulation for AIS has generally not shown benefits that exceed the hemorrhage risks in the acute setting.
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Other acute supportive interventions for AIS include maintaining normoglycemia, euthermia and treating severe hypertension. Recent trials have shown this time window may be extended from 3 to 4.5 hours in select patients. Alteplase must be administered within a short time window to appropriate patients to optimize its therapeutic efficacy. Plasmin targets the blood clot with limited systemic thrombolytic effects. Intravenous alteplase promotes thrombolysis by hydrolyzing plasminogen to form the proteolytic enzyme plasmin.
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Drug treatment of AIS involves intravenous thrombolysis with alteplase (recombinant tissue plasminogen activator ). AIS most commonly occurs when a blood vessel is obstructed leading to irreversible brain injury and subsequent focal neurologic deficits. Marketing Science Consulting Group, Inc.Acute ischemic stroke (AIS) is the fourth leading cause of death and the leading cause of adult disability in the USA.Please carefully read our Terms of Service before you proceed with using any part of this website. Please accept it and choose your preferences by ticking the corresponding boxes in the "Manage Settings" section below. You can change your preferences or withdraw your consent at any time by deleting the cookies from your website or computer as described in the policy. For more details carefully read our Privacy and Cookies Policy. We use cookies to ensure that we give you the best experience on our website. Dansk Deutsch English Español Français Italiano Magyar Nederlands Norsk Polski Português Suomi Svenska Čeština Русский 日本語 简体中文 한국어 Cookie Settings