Antithrombotic and Thrombolytic Therapy for Ischemic Stroke Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Por:
Lansberg, MG, O'Donnell, MJ, Khatri, P, Lang, ES, Nguyen-Huynh, MN, Schwartz, NE, Sonnenberg, FA, Schulman, S, Vandvik, PO, Spencer, FA, Alonso-Coello, P, Guyatt, GH, Akl, EA
Publicada:
1 feb 2012
Resumen:
Objectives: This article provides recommendations on the use of antithrombotic therapy in patients with stroke or transient ischemic attack (TIA).
Methods: We generated treatment recommendations (Grade 1) and suggestions (Grade 2) based on high (A), moderate (B), and low (C) quality evidence.
Results: In patients with acute ischemic stroke, we recommend IV recombinant tissue plasminogen activator (r-tPA) if treatment can be initiated within 3 h (Grade 1A) or 4.5 h (Grade 2C) of symptom onset; we suggest intraarterial r-tPA in patients ineligible for IV tPA if treatment can be initiated within 6 h (Grade 2C); we suggest against the use of mechanical thrombectomy (Grade 2C) although carefully selected patients may choose this intervention; and we recommend early aspirin therapy at a dose of 160 to 325 mg (Grade 1A). In patients with acute stroke and restricted mobility, we suggest the use of prophylactic-dose heparin or intermittent pneumatic compression devices (Grade 2B) and suggest against the use of elastic compression stockings (Grade 2B). In patients with a history of noncardioembolic ischemic stroke or TIA, we recommend long-term treatment with aspirin (75-100 mg once daily), clopidogrel (75 mg once daily), aspirin/extended release dipyridamole (25 mg/200 mg bid), or cilostazol (100 mg bid) over no antiplatelet therapy (Grade 1A), oral anticoagulants (Grade 1B), the combination of clopidogrel plus aspirin (Grade 1B), or triflusal (Grade 2B). Of the recommended antiplatelet regimens, we suggest clopidogrel or aspirin/extended-release dipyridamole over aspirin (Grade 2B) or cilostazol (Grade 2C). In patients with a history of stroke or TIA and atrial fibrillation we recommend oral anticoagulation over no antithrombotic therapy, aspirin, and combination therapy with aspirin and clopidogrel (Grade 1B).
Conclusion: These recommendations can help clinicians make evidence-based treatment decisions with their patients who have had strokes.
Filiaciones:
Lansberg, MG:
Stanford Univ, Stanford Stroke Ctr, Dept Neurol & Neurol Sci, Palo Alto, CA 94304 USA
O'Donnell, MJ:
Natl Univ Ireland Galway, HRB Clin Res Fac, Galway, Ireland
Khatri, P:
Univ Cincinnati, Dept Neurol, Cincinnati, OH USA
Lang, ES:
Univ Calgary, Calgary, AB, Canada
Nguyen-Huynh, MN:
Univ Calif San Francisco, Dept Neurol, San Francisco, CA USA
Schwartz, NE:
Stanford Univ, Stanford Stroke Ctr, Dept Neurol & Neurol Sci, Palo Alto, CA 94304 USA
Sonnenberg, FA:
Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Div Gen Internal Med, New Brunswick, NJ USA
Schulman, S:
McMaster Univ, Dept Med, Hamilton, ON L8S 4L8, Canada
Vandvik, PO:
Norwegian Knowledge Ctr Hlth Serv, Oslo, Norway
Spencer, FA:
St Josephs Healthcare, Hamilton, ON, Canada
Alonso-Coello, P:
CIBERESP IIB St Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
Guyatt, GH:
McMaster Univ, Dept Med, Hamilton, ON L8S 4L8, Canada
McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
Akl, EA:
SUNY Buffalo, Buffalo, NY 14228 USA
McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
Green Published
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