European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke.
Ischaemic stroke
fibrinolysis
recommendations
thrombectomy
thrombolysis
Journal
European stroke journal
ISSN: 2396-9881
Titre abrégé: Eur Stroke J
Pays: England
ID NLM: 101688446
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
30
10
2020
accepted:
27
12
2020
entrez:
5
4
2021
pubmed:
6
4
2021
medline:
6
4
2021
Statut:
ppublish
Résumé
Intravenous thrombolysis is the only approved systemic reperfusion treatment for patients with acute ischaemic stroke. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions with regard to intravenous thrombolysis for acute ischaemic stroke. These guidelines were developed based on the ESO standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote recommendations. Expert consensus statements were provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found high quality evidence to recommend intravenous thrombolysis with alteplase to improve functional outcome in patients with acute ischemic stroke within 4.5 h after symptom onset. We also found high quality evidence to recommend intravenous thrombolysis with alteplase in patients with acute ischaemic stroke on awakening from sleep, who were last seen well more than 4.5 h earlier, who have MRI DWI-FLAIR mismatch, and for whom mechanical thrombectomy is not planned. These guidelines provide further recommendations regarding patient subgroups, late time windows, imaging selection strategies, relative and absolute contraindications to alteplase, and tenecteplase. Intravenous thrombolysis remains a cornerstone of acute stroke management. Appropriate patient selection and timely treatment are crucial. Further randomized controlled clinical trials are needed to inform clinical decision-making with regard to tenecteplase and the use of intravenous thrombolysis before mechanical thrombectomy in patients with large vessel occlusion.
Identifiants
pubmed: 33817340
doi: 10.1177/2396987321989865
pii: 10.1177_2396987321989865
pmc: PMC7995316
doi:
Types de publication
Journal Article
Langues
eng
Pagination
I-LXIISubventions
Organisme : Medical Research Council
ID : G0902303
Pays : United Kingdom
Organisme : Chief Scientist Office
ID : SCAF/17/01
Pays : United Kingdom
Informations de copyright
© European Stroke Organisation 2021.
Déclaration de conflit d'intérêts
Declaration of conflicting interests: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: All disclosures are listed in Supplemental Table 1
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