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New Windows, Same Old House An Update on Acute Stroke Management

New Windows, Same Old House An Update on Acute Stroke Management Acute stroke is a common presentation to emergency departments and is the third leading cause of death in the United States. Despite the frequency of this event, and its substantial morbidity and mortality, few therapies exist to limit the damage from this devastating diagnosis. One pharma- cotherapy for ischemic stroke that has demonstrated efficacy in this setting is tissue plasminogen activator (Activase; tPA; alteplase). Current guidelines for this agent recommend its use within the first 3 hr of the onset of stroke symptoms in patients who meet specified criteria. However, more recent data have lead to recommending the extension of this time frame to 4.5 hr after onset of symptoms in specific patient populations. Although this therapy has demonstrated efficacy in im- proving outcomes, its use is often complicated by complex inclusion and exclusion criteria, risk of hemorrhage, requirement for intense patient monitoring, substantial cost, and the potential for dev- astating medication errors. Key words: alteplase, clinical pharmacy, emergency medicine, stroke, tpa CUTE STROKE is a common presenta- der. Currently, acute stroke affects more than tion to emergency departments (EDs) 700,000 patients per year and is the third lead- A in the United States and recognition ing cause of http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Advanced Emergency Nursing Journal Wolters Kluwer Health

New Windows, Same Old House An Update on Acute Stroke Management

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Copyright
© 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
ISSN
1931-4485
eISSN
1931-4493
DOI
10.1097/TME.0b013e3182542bce
pmid
22561222
Publisher site
See Article on Publisher Site

Abstract

Acute stroke is a common presentation to emergency departments and is the third leading cause of death in the United States. Despite the frequency of this event, and its substantial morbidity and mortality, few therapies exist to limit the damage from this devastating diagnosis. One pharma- cotherapy for ischemic stroke that has demonstrated efficacy in this setting is tissue plasminogen activator (Activase; tPA; alteplase). Current guidelines for this agent recommend its use within the first 3 hr of the onset of stroke symptoms in patients who meet specified criteria. However, more recent data have lead to recommending the extension of this time frame to 4.5 hr after onset of symptoms in specific patient populations. Although this therapy has demonstrated efficacy in im- proving outcomes, its use is often complicated by complex inclusion and exclusion criteria, risk of hemorrhage, requirement for intense patient monitoring, substantial cost, and the potential for dev- astating medication errors. Key words: alteplase, clinical pharmacy, emergency medicine, stroke, tpa CUTE STROKE is a common presenta- der. Currently, acute stroke affects more than tion to emergency departments (EDs) 700,000 patients per year and is the third lead- A in the United States and recognition ing cause of

Journal

Advanced Emergency Nursing Journal – Wolters Kluwer Health

Published: Apr 1, 2012

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