Week 5: Guidelines for Acute Stroke, part 3

Continuing with the stroke guidelines…earlier posts here and here.

Section 3: Endovascular interventions through antiplatelet agents

  • Intra-arterial tPA is actually not well studied. The evidence for intra-arterial thrombolysis is a couple trials with urokinase.
  • Both the Solitaire and the Trevo, stent retrieval devices, outperformed Merci in head-to-head trials
  • Immediate anticoagulation (like for NSTEMIs) hasn’t shown any net benefit
  • Even the evidence of immediate aspirin is kind of weak: two trials individually had a non-significant effect on death/disability when started within 48 hours, but when combined, there was a modest effect, likely attributable to a reduction of early recurrent stroke
  • Plavix takes at least 5 days for full effect when started at 75mg daily
  • Aspirin comes in an IV formulation! But adding it to tPA worsened outcomes.


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2 responses to “Week 5: Guidelines for Acute Stroke, part 3

  1. Pingback: Week 5: Acute Stroke Guidelines, part 4 | Evidenced

  2. Pingback: Week 6: Management of Acute Stroke, part 1 | Evidenced

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