wikidoc - Changes related to "Category:CS1 maint: Explicit use of et al." [en]

Ischemic stroke medical therapy

2026-05-20T14:25:13Z

← Older revision		Revision as of 14:25, 20 May 2026
(6 intermediate revisions by the same user not shown)
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	*The dose of [[aspirin]] is usually between 160-300mg daily.<ref name="pmid9174558">{{cite journal \|vauthors= \|title=The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group \|journal=Lancet \|volume=349 \|issue=9065 \|pages=1569–81 \|date=May 1997 \|pmid=9174558 \|doi= \|url=}}</ref>		*The dose of [[aspirin]] is usually between 160-300mg daily.<ref name="pmid9174558">{{cite journal \|vauthors= \|title=The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group \|journal=Lancet \|volume=349 \|issue=9065 \|pages=1569–81 \|date=May 1997 \|pmid=9174558 \|doi= \|url=}}</ref>
	*[[Aspirin\|IV aspirin]] administration within 90 minutes after the start of [[Alteplase\|IV alteplase]] is associated with symptomatic intracranial hemorrhage, for which co administration is discouraged but benefits should be assessed in each individual case.<ref name="PowersRabinstein2019" /><ref name="ZinkstokRoos2012">{{cite journal\|last1=Zinkstok\|first1=Sanne M\|last2=Roos\|first2=Yvo B\|title=Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial\|journal=The Lancet\|volume=380\|issue=9843\|year=2012\|pages=731–737\|issn=01406736\|doi=10.1016/S0140-6736(12)60949-0}}</ref>		*[[Aspirin\|IV aspirin]] administration within 90 minutes after the start of [[Alteplase\|IV alteplase]] is associated with symptomatic intracranial hemorrhage, for which co administration is discouraged but benefits should be assessed in each individual case.<ref name="PowersRabinstein2019" /><ref name="ZinkstokRoos2012">{{cite journal\|last1=Zinkstok\|first1=Sanne M\|last2=Roos\|first2=Yvo B\|title=Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial\|journal=The Lancet\|volume=380\|issue=9843\|year=2012\|pages=731–737\|issn=01406736\|doi=10.1016/S0140-6736(12)60949-0}}</ref>
	*[[Dual antiplatelet therapy]] with [[aspirin~~]] and [[~~clopidogrel~~]] (75 mg/d, with a loading dose of 600mg) may~~ be started within 24 hours ~~after [[symptom]] onset~~ and continued ~~for~~ 21 days in patients with ~~no cardioembolic [[~~ischemic stroke]].<ref name="~~JohnstonEaston2018~~">{{cite journal\|~~last1~~=Johnston\|~~first1~~=~~S. Claiborne~~\|~~last2~~=~~Easton~~\|~~first2~~=~~J. Donald~~\|~~last3~~=~~Farrant~~\|~~first3~~=~~Mary~~\|~~last4~~=~~Barsan~~\|~~first4~~=~~William~~\|~~last5~~=~~Conwit~~\|~~first5~~=~~Robin~~ A.\|~~last6~~=~~Elm~~\|~~first6~~=~~Jordan J.~~\|~~last7~~=~~Kim~~\|~~first7~~=~~Anthony S.~~\|~~last8~~=~~Lindblad~~\|~~first8~~=~~Anne S~~.\|~~last9~~=~~Palesch~~\|~~first9~~=~~Yuko Y.~~\|title=~~Clopidogrel and Aspirin in~~ Acute Ischemic Stroke ~~and High-Risk TIA~~\|journal=~~New England Journal of Medicine~~\|volume=~~379~~\|issue=3\|~~year~~=~~2018~~\|~~pages~~=~~215–225~~\|~~issn~~=~~0028-4793~~\|doi=10.~~1056~~/~~NEJMoa1800410~~}}</ref>		*[[Dual antiplatelet therapy]] (DAPT) with aspirin plus clopidogrel should be started early (ideally within 24 hours) and continued short term (commonly ~21 days) in patients with minor noncardioembolic ischemic stroke or high-risk TIA who did not receive IV thrombolysis, followed by single antiplatelet therapy.<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref><ref name="pmid33724327">{{cite journal \|vauthors=Mendelson SJ, Prabhakaran S \|title=Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review \|journal=JAMA \|volume=325 \|issue=11 \|pages=1088–1098 \|date=March 2021 \|pmid=33724327 \|doi=10.1001/jama.2020.26867 \|url=}}</ref>.
			*In patients with recent stroke/TIA attributable to severe symptomatic intracranial stenosis (Intracranial athrosclerotic diseas i.e ICAD), DAPT for up to 90 days is reasonable<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref>.
	*[[Aspirin]] should not substitute [[Alteplase\|IV alteplase]] or mechanical thrombectomy in patients eligible for these therapies.<ref name="PowersRabinstein2019" />		*[[Aspirin]] should not substitute [[Alteplase\|IV alteplase]] or mechanical thrombectomy in patients eligible for these therapies.<ref name="PowersRabinstein2019" />

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	\|-		\|-
	\| style="padding: 5px 5px; background: #F5F5F5;" \|'''Reperfusion therapy'''		\| style="padding: 5px 5px; background: #F5F5F5;" \|'''Reperfusion therapy'''
	\| style="padding: 5px 5px; background: #F5F5F5;" \|~~[[Tissue plasminogen activator\|'''Tissue plasminogen activator''']] '''~~(~~t-PA~~)~~'''~~		\| style="padding: 5px 5px; background: #F5F5F5;" \|IV thrombolysis (alteplase or tenecteplase); Endovascular thrombectomy (EVT)
	\| style="padding: 5px 5px; background: #F5F5F5;" \|		\| style="padding: 5px 5px; background: #F5F5F5;" \|
	* Recommended within 3-4.5 hours of onset of ischemic stroke in eligible patients by guidelines<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref><ref name="pmid 22315273">{{cite journal\| author=Lansberg MG, O'Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE et al.\| title=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. \| journal=Chest \| year= 2012 \| volume= 141 \| issue= 2 Suppl \| pages= e601S-36S \| pmid= 22315273 \| doi=10.1378/chest.11-2302 \| pmc=3278065 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315273 }} </ref><ref>{{cite web\|url=http://www.aaem.org/em-resources/position-statements/clinical-practice/thrombolytic-therapy \|title=Position Statement on the Use of Intravenous Thrombolytic Therapy in the Treatment of Stroke \|publisher=American Academy of Emergency Medicine \|accessdate=2008-01-25}}</ref> and [[systematic review]]s<ref name="pmid25871671">{{cite journal\| author=Prabhakaran S, Ruff I, Bernstein RA\| title=Acute stroke intervention: a systematic review. \| journal=JAMA \| year= 2015 \| volume= 313 \| issue= 14 \| pages= 1451-62 \| pmid=25871671 \| doi=10.1001/jama.2015.3058 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25871671 }} </ref><ref name="pmid25072528">{{cite journal\| author=Wardlaw JM, Murray V, Berge E, del Zoppo GJ\| title=Thrombolysis for acute ischaemic stroke. \| journal=Cochrane Database Syst Rev \| year= 2014 \| volume= 7 \| issue= \| pages= CD000213 \| pmid=25072528 \| doi=10.1002/14651858.CD000213.pub3 \| pmc=4153726 \| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25072528 }} </ref><ref name="pmid25106063">{{cite journal\| author=Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E et al.\| title=Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. \| journal=Lancet \| year= 2014 \| volume= \| issue= \| pages= \| pmid=25106063 \| doi=10.1016/S0140-6736(14)60584-5 \| pmc= \| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25106063 }} </ref>		* Recommended within 3-4.5 hours of onset of ischemic stroke in eligible patients by guidelines<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref><ref name="pmid 22315273">{{cite journal\| author=Lansberg MG, O'Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE et al.\| title=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. \| journal=Chest \| year= 2012 \| volume= 141 \| issue= 2 Suppl \| pages= e601S-36S \| pmid= 22315273 \| doi=10.1378/chest.11-2302 \| pmc=3278065 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315273 }} </ref><ref>{{cite web\|url=http://www.aaem.org/em-resources/position-statements/clinical-practice/thrombolytic-therapy \|title=Position Statement on the Use of Intravenous Thrombolytic Therapy in the Treatment of Stroke \|publisher=American Academy of Emergency Medicine \|accessdate=2008-01-25}}</ref> and [[systematic review]]s<ref name="pmid25871671">{{cite journal\| author=Prabhakaran S, Ruff I, Bernstein RA\| title=Acute stroke intervention: a systematic review. \| journal=JAMA \| year= 2015 \| volume= 313 \| issue= 14 \| pages= 1451-62 \| pmid=25871671 \| doi=10.1001/jama.2015.3058 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25871671 }} </ref><ref name="pmid25072528">{{cite journal\| author=Wardlaw JM, Murray V, Berge E, del Zoppo GJ\| title=Thrombolysis for acute ischaemic stroke. \| journal=Cochrane Database Syst Rev \| year= 2014 \| volume= 7 \| issue= \| pages= CD000213 \| pmid=25072528 \| doi=10.1002/14651858.CD000213.pub3 \| pmc=4153726 \| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25072528 }} </ref><ref name="pmid25106063">{{cite journal\| author=Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E et al.\| title=Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. \| journal=Lancet \| year= 2014 \| volume= \| issue= \| pages= \| pmid=25106063 \| doi=10.1016/S0140-6736(14)60584-5 \| pmc= \| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25106063 }} </ref>
			* IV alteplase in eligible patients within ≤4.5 h; tenecteplase 0.25 mg/kg IV bolus may be used as an alternative per protocol <ref name="pmid38884324">{{cite journal \|vauthors=Xiong Y, Campbell BC, Schwamm LH, Meng X, Jin A, Parsons MW, Fisher M, Jiang Y, Che F, Wang L, Zhou L, Dai H, Liu X, Pan Y, Duan C, Xu Y, Xu A, Zong L, Tan Z, Ye W, Wang H, Wang Z, Hao M, Cao Z, Wang L, Wu S, Li H, Li Z, Zhao X, Wang Y \|title=Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy \|journal=N Engl J Med \|volume=391 \|issue=3 \|pages=203–212 \|date=July 2024 \|pmid=38884324 \|doi=10.1056/NEJMoa2402980 \|url=}}</ref>; evaluate urgently for EVT in eligible large-vessel occlusion (LVO).
	\| style="padding: 5px 5px; background: #F5F5F5;" \|		\| style="padding: 5px 5px; background: #F5F5F5;" \|
	* None		* None
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	*Oral administration of [[aspirin]] (initial dose is 325 mg) is recommended within 24 to 48 hours after stroke onset in most patients<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref>		*Oral administration of [[aspirin]] (initial dose is 325 mg) is recommended within 24 to 48 hours after stroke onset in most patients<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref>
	*Aspirin is contraindicated in patients with ischemic stroke within 24 hours of t-PA administration<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref>		*Aspirin is contraindicated in patients with ischemic stroke within 24 hours of t-PA administration<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref>
	*DAPT ~~therapy~~ (aspirin ~~and~~ clopidogrel) ~~is recommended~~ for 90 days in patients with symptomatic intracranial ~~large artery disease~~		*DAPT (aspirin + clopidogrel) for up to 90 days is reasonable only for selected patients with recent stroke/TIA attributable to severe symptomatic intracranial stenosis; routine minor stroke/high-risk TIA DAPT is generally shorter (~21 days) followed by SAPT <ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref> <ref name="pmid33724327">{{cite journal \|vauthors=Mendelson SJ, Prabhakaran S \|title=Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review \|journal=JAMA \|volume=325 \|issue=11 \|pages=1088–1098 \|date=March 2021 \|pmid=33724327 \|doi=10.1001/jama.2020.26867 \|url=}}</ref>.
	\| style="padding: 5px 5px; background: #F5F5F5;" \|		\| style="padding: 5px 5px; background: #F5F5F5;" \|
	* Long term therapy with [[clopidogrel]] or aspirin extended release [[dipyridamole]] may be used for secondary prevention of non cardioembolic stroke		* Long term therapy with [[clopidogrel]] or aspirin extended release [[dipyridamole]] may be used for secondary prevention of non cardioembolic stroke

Non-alcoholic fatty liver disease screening

2026-05-20T01:01:48Z

JAMA article updates

← Older revision		Revision as of 01:01, 20 May 2026
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	__NOTOC__		__NOTOC__
	{{Non alcoholic fatty liver disease}}		{{Non alcoholic fatty liver disease}}
	{{CMG}}; {{AE}} {{VKG}}		{{CMG}}; {{AE}} {{VKG}}[[User:Parth Vikram Singh\|Parth Vikram Singh, MBBS]][3]

	==Overview==		==Overview==
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	* However, American Gastroenterological Association Technical Review recommends screening for non-alcoholic fatty liver disease in population at high risk such as [[obesity]], [[insulin resistance]], and [[metabolic syndrome]].		* However, American Gastroenterological Association Technical Review recommends screening for non-alcoholic fatty liver disease in population at high risk such as [[obesity]], [[insulin resistance]], and [[metabolic syndrome]].
	* Screening is however complicated by the lack of accurate, noninvasive diagnostic tools for NAFLD and the lack of clear treatment that can be proposed to the patient.		* Screening is however complicated by the lack of accurate, noninvasive diagnostic tools for NAFLD and the lack of clear treatment that can be proposed to the patient.
			* Current guidelines summarized in the JAMA review<ref name="pmid41212550">{{cite journal\|vauthors=Tilg H, Petta S, Stefan N, Targher G\|title=Metabolic Dysfunction-Associated Steatotic Liver Disease in Adults: A Review\|journal=JAMA\|volume=335\|issue=2\|pages=163–174\|date=January 2026\|pmid=41212550\|doi=10.1001/jama.2025.19615\|url=}}</ref> recommend a 2-tier testing approach to screen for advanced liver fibrosis in high-risk populations, including individuals with prediabetes or type 2 diabetes, obesity, 2 or more cardiometabolic risk factors, imaging-detected hepatic steatosis, or persistently elevated serum aminotransferase levels.
	~~However~~, the AGA ~~recommend~~ screening<ref name="pmid37542503">{{cite journal\| author=Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ\| title=AGA Clinical Practice Update on the Role of Noninvasive Biomarkers in the Evaluation and Management of Nonalcoholic Fatty Liver Disease: Expert Review. \| journal=Gastroenterology \| year= 2023 \| volume= \| issue= \| pages= \| pmid=37542503 \| doi=10.1053/j.gastro.2023.06.013 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37542503 }} </ref>.		** The first step is calculation of the Fibrosis-4 index, usually performed in primary care. Patients with a Fibrosis-4 index greater than 1.3 should undergo vibration-controlled transient elastography or another noninvasive test, such as the enhanced liver fibrosis test. Patients with liver stiffness greater than 8.0 kPa or an enhanced liver fibrosis test score greater than 9.8 should be referred to a hepatologist.
			** Patients with a FIB-4 score less than 1.3 should undergo lifestyle modification, avoidance of alcohol intake, and treatment of type 2 diabetes, obesity, dyslipidemia, and hypertension. Repeat FIB-4 testing may be performed every 1 to 3 years. Patients with indeterminate or high-risk findings should undergo additional noninvasive fibrosis assessment and may require hepatology referral.
			{\| class="wikitable"
			\|'''FIB-4 score'''
			\|'''Interpretation'''
			\|-
			\|<1.30
			\|Low risk of advanced fibrosis
			\|-
			\|1.30-2.67
			\|Indeterminate risk of advanced fibrosis
			\|-
			\|>2.67
			\|High risk of advanced fibrosis
			\|}
			The AGA also recommends screening<ref name="pmid37542503">{{cite journal\| author=Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ\| title=AGA Clinical Practice Update on the Role of Noninvasive Biomarkers in the Evaluation and Management of Nonalcoholic Fatty Liver Disease: Expert Review. \| journal=Gastroenterology \| year= 2023 \| volume= \| issue= \| pages= \| pmid=37542503 \| doi=10.1053/j.gastro.2023.06.013 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37542503 }} </ref>.

	Workflows to promote screening may increase treatment<ref name="pmid37549979">{{cite journal\| author=Zhang X, Yip TC, Wong GL, Leow WX, Liang LY, Lim LL \| display-authors=etal\| title=Clinical care pathway to detect advanced liver disease in patients with type 2 diabetes through automated fibrosis score calculation and electronic reminder messages: a randomised controlled trial. \| journal=Gut \| year= 2023 \| volume= \| issue= \| pages= \| pmid=37549979 \| doi=10.1136/gutjnl-2023-330269 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37549979 }} </ref>.		Workflows to promote screening may increase treatment<ref name="pmid37549979">{{cite journal\| author=Zhang X, Yip TC, Wong GL, Leow WX, Liang LY, Lim LL \| display-authors=etal\| title=Clinical care pathway to detect advanced liver disease in patients with type 2 diabetes through automated fibrosis score calculation and electronic reminder messages: a randomised controlled trial. \| journal=Gut \| year= 2023 \| volume= \| issue= \| pages= \| pmid=37549979 \| doi=10.1136/gutjnl-2023-330269 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37549979 }} </ref>.

Non-alcoholic fatty liver disease risk factors

2026-05-20T00:56:27Z

JAMA article updates

← Older revision		Revision as of 00:56, 20 May 2026
Line 1:		Line 1:
	__NOTOC__		__NOTOC__
	{{Non alcoholic fatty liver disease}}		{{Non alcoholic fatty liver disease}}
	{{CMG}}; {{AE}} {{VKG}}		{{CMG}}; {{AE}} {{VKG}} [[User:Parth Vikram Singh\|Parth Vikram Singh, MBBS]][3]

	==Overview==		==Overview==
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	==Risk Factors==		==Risk Factors==
	Risk factors in the development of non-alcoholic fatty liver disease include:<ref name="pmid25892859">{{cite journal\| author=Streba LA, Vere CC, Rogoveanu I, Streba CT\| title=Nonalcoholic fatty liver disease, metabolic risk factors, and hepatocellular carcinoma: an open question. \| journal=World J Gastroenterol \| year= 2015 \| volume= 21 \| issue= 14 \| pages= 4103-10 \| pmid=25892859 \| doi=10.3748/wjg.v21.i14.4103 \| pmc=4394070 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25892859 }} </ref><ref name="pmid22319959">{{cite journal\| author=He S, Bao W, Shao M, Wang W, Wang C, Sun J et al.\| title=Risk factors for non-alcoholic fatty liver disease in a Chinese population. \| journal=Acta Gastroenterol Belg \| year= 2011 \| volume= 74 \| issue= 4 \| pages= 503-8 \| pmid=22319959 \| doi= \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22319959 }} </ref><ref name="pmid258928592">{{cite journal \|vauthors=Streba LA, Vere CC, Rogoveanu I, Streba CT \|title=Nonalcoholic fatty liver disease, metabolic risk factors, and hepatocellular carcinoma: an open question \|journal=World J. Gastroenterol. \|volume=21 \|issue=14 \|pages=4103–10 \|year=2015 \|pmid=25892859 \|pmc=4394070 \|doi=10.3748/wjg.v21.i14.4103 \|url=}}</ref>		Risk factors in the development of non-alcoholic fatty liver disease include:<ref name="pmid25892859">{{cite journal\| author=Streba LA, Vere CC, Rogoveanu I, Streba CT\| title=Nonalcoholic fatty liver disease, metabolic risk factors, and hepatocellular carcinoma: an open question. \| journal=World J Gastroenterol \| year= 2015 \| volume= 21 \| issue= 14 \| pages= 4103-10 \| pmid=25892859 \| doi=10.3748/wjg.v21.i14.4103 \| pmc=4394070 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25892859 }} </ref><ref name="pmid22319959">{{cite journal\| author=He S, Bao W, Shao M, Wang W, Wang C, Sun J et al.\| title=Risk factors for non-alcoholic fatty liver disease in a Chinese population. \| journal=Acta Gastroenterol Belg \| year= 2011 \| volume= 74 \| issue= 4 \| pages= 503-8 \| pmid=22319959 \| doi= \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22319959 }} </ref><ref name="pmid258928592">{{cite journal \|vauthors=Streba LA, Vere CC, Rogoveanu I, Streba CT \|title=Nonalcoholic fatty liver disease, metabolic risk factors, and hepatocellular carcinoma: an open question \|journal=World J. Gastroenterol. \|volume=21 \|issue=14 \|pages=4103–10 \|year=2015 \|pmid=25892859 \|pmc=4394070 \|doi=10.3748/wjg.v21.i14.4103 \|url=}}</ref><ref name="pmid412125502">{{cite journal\|vauthors=Tilg H, Petta S, Stefan N, Targher G\|title=Metabolic Dysfunction-Associated Steatotic Liver Disease in Adults: A Review\|journal=JAMA\|volume=335\|issue=2\|pages=163–174\|date=January 2026\|pmid=41212550\|doi=10.1001/jama.2025.19615\|url=}}</ref>
	*[[Viral hepatitis]]		*[[Viral hepatitis]]
	*Rapid [[weight loss]]		*Rapid [[weight loss]]
	*[[Malnutrition]]		*[[Malnutrition]]
	*[[Hypertriglyceridemia]]		*[[Hypertriglyceridemia]]
			*Low HDL cholesterol
	*[[Sleep apnea]]		*[[Sleep apnea]]
	*[[Hypothyroidism]]		*[[Hypothyroidism]]
	*[[Obesity]]		*Abdominal overweight or [[Obesity]]
	*[[Hypopituitarism]]		*[[Hypopituitarism]]
	*[[Diabetes mellitus type 2]]		*Prediabetes or [[Diabetes mellitus type 2]]
			*Insulin resistance
			*Hypertension
	*[[Polycystic ovary syndrome\|PCOS]] ([[polycystic ovarian syndrome]])		*[[Polycystic ovary syndrome\|PCOS]] ([[polycystic ovarian syndrome]])
			*Older age
			*Male sex
			*Postmenopausal status
			*PNPLA3 and TM6SF2 genetic variants
			*Sedentary lifestyle
			*Smoking
			*High intake of fructose, especially from sugar-sweetened beverages
			*High-calorie diets rich in saturated fats, sugars, and processed foods
			*Alcohol intake above MASLD thresholds
	*Medications like [[tamoxifen]], [[corticosteriods]], [[methotrexate]]		*Medications like [[tamoxifen]], [[corticosteriods]], [[methotrexate]]


			Cardiometabolic risk factors used in the classification of MASLD include body mass index of 25 or greater, or 23 or greater in Asian individuals; waist circumference of 80 cm or greater in women and 94 cm or greater in men; fasting glucose level of 5.6 mmol/L or greater, 2-hour postload glucose level of 7.8 mmol/L or greater, hemoglobin A1c level of 5.7% or greater, established type 2 diabetes, or use of glucose-lowering medication; blood pressure of 130/85 mm Hg or greater or use of antihypertensive medication; plasma triglyceride level of 1.70 mmol/L or greater or use of triglyceride-lowering medication; and low HDL cholesterol.

	==References==		==References==
	{{reflist\|2}}		{{reflist\|2}}

Non-alcoholic fatty liver disease epidemiology and demographics

2026-05-20T00:49:32Z

JAMA article updates

← Older revision		Revision as of 00:49, 20 May 2026
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	__NOTOC__		__NOTOC__
	{{Non alcoholic fatty liver disease}}		{{Non alcoholic fatty liver disease}}
	{{CMG}}; {{AE}} {{VKG}}		{{CMG}}; {{AE}} {{VKG}} [[User:Parth Vikram Singh\|Parth Vikram Singh, MBBS]][3]

	==Overview==		==Overview==
Line 17:		Line 17:

	===Prevalance===		===Prevalance===
			* MASLD is the most common chronic liver disease worldwide. Approximately 30% to 40% of adults worldwide have MASLD. The prevalence is substantially higher among individuals with type 2 diabetes and obesity, affecting approximately 60% to 70% of individuals with type 2 diabetes and approximately 70% to 80% of individuals with obesity.<ref name="pmid41212550">{{cite journal\|vauthors=Tilg H, Petta S, Stefan N, Targher G\|title=Metabolic Dysfunction-Associated Steatotic Liver Disease in Adults: A Review\|journal=JAMA\|volume=335\|issue=2\|pages=163–174\|date=January 2026\|pmid=41212550\|doi=10.1001/jama.2025.19615\|url=}}</ref>
			* In a systematic review of 92 population-based studies from 1990 to 2019, the highest prevalence of ultrasound-detected MASLD was observed in Latin America and the lowest in Western Europe. By 2040, the global prevalence of MASLD among adults is projected to exceed 55%. In 2021, the global age-standardized prevalence of MASLD was 15,018 per 100,000 population, and the annual incidence was 608 per 100,000 population. The prevalence was higher in men than women and peaked at 45 to 49 years of age in men and 50 to 54 years of age in women.
			* Among individuals with type 2 diabetes, the global pooled prevalence of MASLD based on ultrasonography was 65.3%. Among individuals with type 2 diabetes who had liver biopsy data, the global histological prevalence of MASH was 66.4%, stage F2 fibrosis was present in 40.8%, and advanced fibrosis, defined as stage F3 or F4, was present in 15.5%.
	* The prevalence of non-alcoholic liver disease in the United States is estimated to be 10,000 to 24,000 cases per 100,000 individuals annually.		* The prevalence of non-alcoholic liver disease in the United States is estimated to be 10,000 to 24,000 cases per 100,000 individuals annually.

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	=== Gender ===		=== Gender ===
	* Men are more commonly affected by non-alcoholic liver disease than women.		* Men are more commonly affected by non-alcoholic liver disease than women. In global 2021 estimates, prevalence peaked at 45 to 49 years of age in men and at 50 to 54 years of age in women.
	* Among women it is more common in post-menopausal women than pre-menopausal.		* Among women it is more common in post-menopausal women than pre-menopausal.

Ischemic stroke medical therapy

2026-05-18T19:59:42Z

← Older revision		Revision as of 19:59, 18 May 2026
Line 26:		Line 26:

	*[[Alteplase\|IV alteplase]] is recommended for selected patients who can be treated within 3-4.5 hours of [[ischemic stroke]] [[symptom]] [[onset]] or patient last known well or at [[Baseline (medicine)\|baseline]] state.<ref name="LeesEmberson2016">{{cite journal\|last1=Lees\|first1=Kennedy R.\|last2=Emberson\|first2=Jonathan\|last3=Blackwell\|first3=Lisa\|last4=Bluhmki\|first4=Erich\|last5=Davis\|first5=Stephen M.\|last6=Donnan\|first6=Geoffrey A.\|last7=Grotta\|first7=James C.\|last8=Kaste\|first8=Markku\|last9=von Kummer\|first9=Rüdiger\|last10=Lansberg\|first10=Maarten G.\|last11=Lindley\|first11=Richard I.\|last12=Lyden\|first12=Patrick\|last13=Murray\|first13=Gordon D.\|last14=Sandercock\|first14=Peter A.G.\|last15=Toni\|first15=Danilo\|last16=Toyoda\|first16=Kazunori\|last17=Wardlaw\|first17=Joanna M.\|last18=Whiteley\|first18=William N.\|last19=Baigent\|first19=Colin\|last20=Hacke\|first20=Werner\|last21=Howard\|first21=George\|last22=Marler\|first22=John\|last23=Halls\|first23=Heather\|last24=Holland\|first24=Lisa\|last25=Mathews\|first25=Clare\|last26=Smith\|first26=Samantha\|last27=Wilson\|first27=Kate\|last28=Koga\|first28=Masatoshi\|last29=Albers\|first29=Gregory\|last30=Brott\|first30=Thomas\|last31=Cohen\|first31=Geoffrey\|last32=Koga\|first32=Masatoshi\|last33=Olivot\|first33=Jean Marc\|last34=Parsons\|first34=Mark\|last35=Tilley\|first35=Barbara\|last36=Wahlgren\|first36=Nils\|last37=del Zoppo\|first37=Gregory J\|title=Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes\|journal=Stroke\|volume=47\|issue=9\|year=2016\|pages=2373–2379\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.013644}}</ref><ref name="PowersRabinstein2019" /><ref>{{cite journal\|title=The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial\|journal=The Lancet\|volume=379\|issue=9834\|year=2012\|pages=2352–2363\|issn=01406736\|doi=10.1016/S0140-6736(12)60768-5}}</ref>		*[[Alteplase\|IV alteplase]] is recommended for selected patients who can be treated within 3-4.5 hours of [[ischemic stroke]] [[symptom]] [[onset]] or patient last known well or at [[Baseline (medicine)\|baseline]] state.<ref name="LeesEmberson2016">{{cite journal\|last1=Lees\|first1=Kennedy R.\|last2=Emberson\|first2=Jonathan\|last3=Blackwell\|first3=Lisa\|last4=Bluhmki\|first4=Erich\|last5=Davis\|first5=Stephen M.\|last6=Donnan\|first6=Geoffrey A.\|last7=Grotta\|first7=James C.\|last8=Kaste\|first8=Markku\|last9=von Kummer\|first9=Rüdiger\|last10=Lansberg\|first10=Maarten G.\|last11=Lindley\|first11=Richard I.\|last12=Lyden\|first12=Patrick\|last13=Murray\|first13=Gordon D.\|last14=Sandercock\|first14=Peter A.G.\|last15=Toni\|first15=Danilo\|last16=Toyoda\|first16=Kazunori\|last17=Wardlaw\|first17=Joanna M.\|last18=Whiteley\|first18=William N.\|last19=Baigent\|first19=Colin\|last20=Hacke\|first20=Werner\|last21=Howard\|first21=George\|last22=Marler\|first22=John\|last23=Halls\|first23=Heather\|last24=Holland\|first24=Lisa\|last25=Mathews\|first25=Clare\|last26=Smith\|first26=Samantha\|last27=Wilson\|first27=Kate\|last28=Koga\|first28=Masatoshi\|last29=Albers\|first29=Gregory\|last30=Brott\|first30=Thomas\|last31=Cohen\|first31=Geoffrey\|last32=Koga\|first32=Masatoshi\|last33=Olivot\|first33=Jean Marc\|last34=Parsons\|first34=Mark\|last35=Tilley\|first35=Barbara\|last36=Wahlgren\|first36=Nils\|last37=del Zoppo\|first37=Gregory J\|title=Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes\|journal=Stroke\|volume=47\|issue=9\|year=2016\|pages=2373–2379\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.013644}}</ref><ref name="PowersRabinstein2019" /><ref>{{cite journal\|title=The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial\|journal=The Lancet\|volume=379\|issue=9834\|year=2012\|pages=2352–2363\|issn=01406736\|doi=10.1016/S0140-6736(12)60768-5}}</ref>
			*In imaging-selected patients with wake-up stroke/unknown onset or extended-window presentations, IV thrombolysis may be beneficial when selection criteria are met<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref><ref name="pmid31067369">{{cite journal \|vauthors=Ma H, Campbell BC, Parsons MW, Churilov L, Levi CR, Hsu C, Kleinig TJ, Wijeratne T, Curtze S, Dewey HM, Miteff F, Tsai CH, Lee JT, Phan TG, Mahant N, Sun MC, Krause M, Sturm J, Grimley R, Chen CH, Hu CJ, Wong AA, Field D, Sun Y, Barber PA, Sabet A, Jannes J, Jeng JS, Clissold B, Markus R, Lin CH, Lien LM, Bladin CF, Christensen S, Yassi N, Sharma G, Bivard A, Desmond PM, Yan B, Mitchell PJ, Thijs V, Carey L, Meretoja A, Davis SM, Donnan GA \|title=Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke \|journal=N Engl J Med \|volume=380 \|issue=19 \|pages=1795–1803 \|date=May 2019 \|pmid=31067369 \|doi=10.1056/NEJMoa1813046 \|url=}}</ref>.
	*The [[dose]] of [[Alteplase\|IV alteplase]] is 0.9 mg/kg (maximum dose 90 mg) over 60 min, with 10% of the [[dose]] given as a [[bolus]] over 1 min.<ref name="PowersRabinstein2019" />		*The [[dose]] of [[Alteplase\|IV alteplase]] is 0.9 mg/kg (maximum dose 90 mg) over 60 min, with 10% of the [[dose]] given as a [[bolus]] over 1 min.<ref name="PowersRabinstein2019" />
	*[[Alteplase\|IV alteplase]] should be initiated as soon as possible, having been demonstrated better outcomes the sooner is administered.<ref name="PowersRabinstein2019" />		*[[Alteplase\|IV alteplase]] should be initiated as soon as possible, having been demonstrated better outcomes the sooner is administered.<ref name="PowersRabinstein2019" />
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	====Tenecteplase====		====Tenecteplase====

	*[[Tenecteplase]] ~~may be useful~~ in patients ~~with minor [[neurological]] impairment.~~<ref name="~~HuangCheripelli2015~~">{{cite journal\|~~last1~~=~~Huang~~\|~~first1~~=~~Xuya~~\|~~last2~~=~~Cheripelli~~\|~~first2~~=~~Bharath Kumar~~\|~~last3~~=~~Lloyd~~\|~~first3~~=~~Suzanne M~~\|~~last4~~=~~Kalladka~~\|~~first4~~=~~Dheeraj~~\|~~last5~~=~~Moreton~~\|~~first5~~=~~Fiona Catherine\|last6~~=~~Siddiqui~~\|~~first6~~=~~Aslam\|last7=Ford\|first7=Ian\|last8=Muir\|first8=Keith W~~\|title=~~Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST)~~: ~~a phase 2, randomised, open-label, blinded endpoint study~~\|journal=~~The Lancet Neurology~~\|volume=14\|issue=4\|~~year~~=~~2015~~\|~~pages~~=~~368–376~~\|~~issn~~=~~14744422~~\|doi=10.1016/~~S1474-4422(15)70017-7~~}}</ref>		*[[Tenecteplase]] is a reasonable alternative to alteplase for IV thrombolysis in eligible acute ischemic stroke patients and is administered as a single IV bolus <ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref><ref name="pmid37479410">{{cite journal \|vauthors=Lo BM, Carpenter CR, Ducey S, Gottlieb M, Kaji A, Diercks DB, Diercks DB, Wolf SJ, Anderson JD, Byyny R, Carpenter CR, Friedman B, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Hatten BW, Haukoos JS, Kaji A, Kwok H, Lo BM, Mace SE, Moran M, Promes SB, Shah KH, Shih RD, Silvers SM, Slivinski A, Smith MD, Thiessen ME, Tomaszewski CA, Trent S, Valente JH, Wall SP, Westafer LM, Yu Y, Cantrill SV, Finnell JT, Schulz T, Vandertulip K \|title=Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Ischemic Stroke \|journal=Ann Emerg Med \|volume=82 \|issue=2 \|pages=e17–e64 \|date=August 2023 \|pmid=37479410 \|doi=10.1016/j.annemergmed.2023.03.007 \|url=}}</ref>
	*The dose of [[tenecteplase]] is ~~a single IV [[bolus]] of~~ 0.25-mg/kg (maximum 25 mg).<ref name="~~CampbellMitchell2018~~">{{cite journal\|~~last1~~=~~Campbell~~\|~~first1~~=~~Bruce C.V.~~\|~~last2~~=~~Mitchell~~\|~~first2~~=~~Peter J.~~\|~~last3~~=~~Churilov~~\|~~first3~~=~~Leonid~~\|~~last4~~=~~Yassi~~\|~~first4~~=~~Nawaf~~\|~~last5~~=~~Kleinig~~\|~~first5~~=~~Timothy J~~.\|~~last6~~=Dowling~~\|first6=Richard J.\|last7=~~Yan~~\|first7=Bernard\|last8=~~Bush~~\|first8=Steven J.\|last9=~~Dewey~~\|first9=Helen M.\|last10=~~Thijs~~\|first10=Vincent\|last11=~~Scroop~~\|first11=Rebecca\|last12=~~Simpson~~\|first12=Marion\|last13=~~Brooks~~\|first13=Mark\|last14=~~Asadi~~\|first14=Hamed\|last15=~~Wu~~\|first15=Teddy Y.\|last16=~~Shah~~\|first16=Darshan G.\|last17=~~Wijeratne~~\|first17=Tissa\|last18=~~Ang~~\|first18=Timothy\|last19=~~Miteff~~\|first19=Ferdinand\|last20=~~Levi~~\|first20=Christopher R.\|last21=~~Rodrigues~~\|first21=Edrich\|last22=~~Zhao~~\|first22=Henry\|last23=~~Salvaris~~\|first23=Patrick\|last24=~~Garcia-Esperon~~\|first24=Carlos\|last25=~~Bailey~~\|first25=Peter\|last26=~~Rice~~\|first26=Henry\|last27=~~de Villiers~~\|first27=Laetitia\|last28=~~Brown~~\|first28=Helen\|last29=~~Redmond~~\|first29=Kendal\|last30=~~Leggett~~\|first30=David\|last31=~~Fink~~\|first31=John N.\|last32=~~Collecutt~~\|first32=Wayne\|last33=~~Wong~~\|first33=Andrew A.\|last34=~~Muller~~\|first34=Claire\|last35=~~Coulthard~~\|first35=Alan\|last36=~~Mitchell~~\|first36=Ken\|last37=~~Clouston~~\|first37=John\|last38=~~Mahady~~\|first38=Kate\|last39=~~Field~~\|first39=Deborah\|last40=~~Ma~~\|first40=Henry\|last41=~~Phan~~\|first41=Thanh G.\|last42=~~Chong~~\|first42=Winston\|last43=~~Chandra~~\|first43=Ronil V.\|last44=~~Slater~~\|first44=Lee-Anne\|last45=~~Krause~~\|first45=Martin\|last46=~~Harrington~~\|first46=Timothy J.\|last47=~~Faulder\|~~first47~~=~~Kenneth C.~~\|~~last48~~=~~Steinfort~~\|~~first48~~=~~Brendan S.~~\|~~last49~~=~~Bladin~~\|~~first49~~=~~Christopher F.~~\|~~last50~~=~~Sharma~~\|~~first50~~=~~Gagan~~\|~~last51~~=~~Desmond\|first51=Patricia M~~.\|~~last52~~=~~Parsons\|first52=Mark W~~.~~\|last53~~=~~Donnan~~\|~~first53~~=~~Geoffrey~~ A~~.\|last54=Davis\|first54=Stephen~~ M.\|title=Tenecteplase ~~versus Alteplase before Thrombectomy~~ for Ischemic Stroke\|journal=~~New England Journal of Medicine~~\|volume=~~378~~\|issue=17\|~~year~~=~~2018~~\|~~pages~~=~~1573–1582~~\|~~issn~~=~~0028-4793~~\|doi=10.1056/~~NEJMoa1716405~~}}</ref>		*The dose of [[tenecteplase]] is 0.25 mg/kg IV bolus (maximum 25 mg).<ref name="pmid37479410">{{cite journal \|vauthors=Lo BM, Carpenter CR, Ducey S, Gottlieb M, Kaji A, Diercks DB, Diercks DB, Wolf SJ, Anderson JD, Byyny R, Carpenter CR, Friedman B, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Hatten BW, Haukoos JS, Kaji A, Kwok H, Lo BM, Mace SE, Moran M, Promes SB, Shah KH, Shih RD, Silvers SM, Slivinski A, Smith MD, Thiessen ME, Tomaszewski CA, Trent S, Valente JH, Wall SP, Westafer LM, Yu Y, Cantrill SV, Finnell JT, Schulz T, Vandertulip K \|title=Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Ischemic Stroke \|journal=Ann Emerg Med \|volume=82 \|issue=2 \|pages=e17–e64 \|date=August 2023 \|pmid=37479410 \|doi=10.1016/j.annemergmed.2023.03.007 \|url=}}</ref>
			*Among patients with LVO planned for thrombectomy, tenecteplase (0.25 mg/kg) achieved higher early reperfusion than alteplase (22% vs 10%) and improved 90-day functional outcome (median mRS 2 vs 3) with similar symptomatic ICH (1% vs 1%) in EXTEND-IA TNK.<ref name="pmid29694815">{{cite journal \|vauthors=Campbell BC, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, Yan B, Bush SJ, Dewey HM, Thijs V, Scroop R, Simpson M, Brooks M, Asadi H, Wu TY, Shah DG, Wijeratne T, Ang T, Miteff F, Levi CR, Rodrigues E, Zhao H, Salvaris P, Garcia-Esperon C, Bailey P, Rice H, de Villiers L, Brown H, Redmond K, Leggett D, Fink JN, Collecutt W, Wong AA, Muller C, Coulthard A, Mitchell K, Clouston J, Mahady K, Field D, Ma H, Phan TG, Chong W, Chandra RV, Slater LA, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Bladin CF, Sharma G, Desmond PM, Parsons MW, Donnan GA, Davis SM \|title=Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke \|journal=N Engl J Med \|volume=378 \|issue=17 \|pages=1573–1582 \|date=April 2018 \|pmid=29694815 \|doi=10.1056/NEJMoa1716405 \|url=}}</ref>
			*[[Tenecteplase]] has also shown benefit in selected patients treated 4.5–24 hours after onset when thrombectomy is not available in TRACE-III<ref name="pmid38884324">{{cite journal \|vauthors=Xiong Y, Campbell BC, Schwamm LH, Meng X, Jin A, Parsons MW, Fisher M, Jiang Y, Che F, Wang L, Zhou L, Dai H, Liu X, Pan Y, Duan C, Xu Y, Xu A, Zong L, Tan Z, Ye W, Wang H, Wang Z, Hao M, Cao Z, Wang L, Wu S, Li H, Li Z, Zhao X, Wang Y \|title=Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy \|journal=N Engl J Med \|volume=391 \|issue=3 \|pages=203–212 \|date=July 2024 \|pmid=38884324 \|doi=10.1056/NEJMoa2402980 \|url=}}</ref>.

	====Antiplatelet therapy====		====Antiplatelet therapy====

Ventricular arrhythmias

2026-05-18T05:18:24Z

Show changes

Ischemic stroke medical therapy

2026-05-17T13:26:26Z

← Older revision		Revision as of 13:26, 17 May 2026
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	*The usefulness of [[anticoagulants]] such as [[thrombin]] inhibitors ([[dabigatran]]) and [[factor Xa]] inhibitors ([[rivaroxaban]], [[apixaban]], [[edoxaban]]) is not well established in the acute setting of [[stroke]].<ref name="GioiaKate2016">{{cite journal\|last1=Gioia\|first1=Laura C.\|last2=Kate\|first2=Mahesh\|last3=Sivakumar\|first3=Leka\|last4=Hussain\|first4=Dulara\|last5=Kalashyan\|first5=Hayrapet\|last6=Buck\|first6=Brian\|last7=Bussiere\|first7=Miguel\|last8=Jeerakathil\|first8=Thomas\|last9=Shuaib\|first9=Ashfaq\|last10=Emery\|first10=Derek\|last11=Butcher\|first11=Ken\|title=Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation\|journal=Stroke\|volume=47\|issue=7\|year=2016\|pages=1917–1919\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.013491}}</ref>		*The usefulness of [[anticoagulants]] such as [[thrombin]] inhibitors ([[dabigatran]]) and [[factor Xa]] inhibitors ([[rivaroxaban]], [[apixaban]], [[edoxaban]]) is not well established in the acute setting of [[stroke]].<ref name="GioiaKate2016">{{cite journal\|last1=Gioia\|first1=Laura C.\|last2=Kate\|first2=Mahesh\|last3=Sivakumar\|first3=Leka\|last4=Hussain\|first4=Dulara\|last5=Kalashyan\|first5=Hayrapet\|last6=Buck\|first6=Brian\|last7=Bussiere\|first7=Miguel\|last8=Jeerakathil\|first8=Thomas\|last9=Shuaib\|first9=Ashfaq\|last10=Emery\|first10=Derek\|last11=Butcher\|first11=Ken\|title=Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation\|journal=Stroke\|volume=47\|issue=7\|year=2016\|pages=1917–1919\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.013491}}</ref>
	*The use of [[thrombolysis]] via ultrasound waves concomitant to [[Fibrinolysis\|IV fibrinolysis]] is not recommended.<ref name="NacuKvistad2017">{{cite journal\|last1=Nacu\|first1=Aliona\|last2=Kvistad\|first2=Christopher E.\|last3=Naess\|first3=Halvor\|last4=Øygarden\|first4=Halvor\|last5=Logallo\|first5=Nicola\|last6=Assmus\|first6=Jörg\|last7=Waje-Andreassen\|first7=Ulrike\|last8=Kurz\|first8=Kathinka D.\|last9=Neckelmann\|first9=Gesche\|last10=Thomassen\|first10=Lars\|title=NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study)\|journal=Stroke\|volume=48\|issue=2\|year=2017\|pages=335–341\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.014644}}</ref>		*The use of [[thrombolysis]] via ultrasound waves concomitant to [[Fibrinolysis\|IV fibrinolysis]] is not recommended.<ref name="NacuKvistad2017">{{cite journal\|last1=Nacu\|first1=Aliona\|last2=Kvistad\|first2=Christopher E.\|last3=Naess\|first3=Halvor\|last4=Øygarden\|first4=Halvor\|last5=Logallo\|first5=Nicola\|last6=Assmus\|first6=Jörg\|last7=Waje-Andreassen\|first7=Ulrike\|last8=Kurz\|first8=Kathinka D.\|last9=Neckelmann\|first9=Gesche\|last10=Thomassen\|first10=Lars\|title=NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study)\|journal=Stroke\|volume=48\|issue=2\|year=2017\|pages=335–341\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.014644}}</ref>
			*Tenecteplase (0.25 mg/kg IV bolus; max 25 mg) is an accepted alternative to alteplase (0.9 mg/kg; max 90 mg with 10% bolus then 60-minute infusion) in thrombolysis-eligible patients, ideally using an institutional protocol.<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref><ref name="pmid37479410">{{cite journal \|vauthors=Lo BM, Carpenter CR, Ducey S, Gottlieb M, Kaji A, Diercks DB, Diercks DB, Wolf SJ, Anderson JD, Byyny R, Carpenter CR, Friedman B, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Hatten BW, Haukoos JS, Kaji A, Kwok H, Lo BM, Mace SE, Moran M, Promes SB, Shah KH, Shih RD, Silvers SM, Slivinski A, Smith MD, Thiessen ME, Tomaszewski CA, Trent S, Valente JH, Wall SP, Westafer LM, Yu Y, Cantrill SV, Finnell JT, Schulz T, Vandertulip K \|title=Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Ischemic Stroke \|journal=Ann Emerg Med \|volume=82 \|issue=2 \|pages=e17–e64 \|date=August 2023 \|pmid=37479410 \|doi=10.1016/j.annemergmed.2023.03.007 \|url=}}</ref>
	*High-intensity [[statin]] therapy should be initiated in patients younger than 75 with clinical [[Coronary heart disease\|ASCVD]], to achieving a reduction in [[LDL-C]] levels of at least 50%.		*High-intensity [[statin]] therapy should be initiated in patients younger than 75 with clinical [[Coronary heart disease\|ASCVD]], to achieving a reduction in [[LDL-C]] levels of at least 50%.
	*In patients older than 75 years of age with clinical [[Coronary heart disease\|ASCVD]], it is reasonable to initiate moderate or high-intensity [[statin]] therapy after reviewing [[adverse effects]] and [[Drug interaction\|drug interactions]].<ref name="PowersRabinstein2019">{{cite journal\|last1=Powers\|first1=William J.\|last2=Rabinstein\|first2=Alejandro A.\|last3=Ackerson\|first3=Teri\|last4=Adeoye\|first4=Opeolu M.\|last5=Bambakidis\|first5=Nicholas C.\|last6=Becker\|first6=Kyra\|last7=Biller\|first7=José\|last8=Brown\|first8=Michael\|last9=Demaerschalk\|first9=Bart M.\|last10=Hoh\|first10=Brian\|last11=Jauch\|first11=Edward C.\|last12=Kidwell\|first12=Chelsea S.\|last13=Leslie-Mazwi\|first13=Thabele M.\|last14=Ovbiagele\|first14=Bruce\|last15=Scott\|first15=Phillip A.\|last16=Sheth\|first16=Kevin N.\|last17=Southerland\|first17=Andrew M.\|last18=Summers\|first18=Deborah V.\|last19=Tirschwell\|first19=David L.\|title=Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association\|journal=Stroke\|volume=50\|issue=12\|year=2019\|issn=0039-2499\|doi=10.1161/STR.0000000000000211}}</ref><ref name="SanossianSaver2006">{{cite journal\|last1=Sanossian\|first1=Nerses\|last2=Saver\|first2=Jeffrey L.\|last3=Liebeskind\|first3=David S.\|last4=Kim\|first4=Doojin\|last5=Razinia\|first5=Tannaz\|last6=Ovbiagele\|first6=Bruce\|title=Achieving Target Cholesterol Goals After Stroke\|journal=Archives of Neurology\|volume=63\|issue=8\|year=2006\|pages=1081\|issn=0003-9942\|doi=10.1001/archneur.63.8.1081}}</ref>		*In patients older than 75 years of age with clinical [[Coronary heart disease\|ASCVD]], it is reasonable to initiate moderate or high-intensity [[statin]] therapy after reviewing [[adverse effects]] and [[Drug interaction\|drug interactions]].<ref name="PowersRabinstein2019">{{cite journal\|last1=Powers\|first1=William J.\|last2=Rabinstein\|first2=Alejandro A.\|last3=Ackerson\|first3=Teri\|last4=Adeoye\|first4=Opeolu M.\|last5=Bambakidis\|first5=Nicholas C.\|last6=Becker\|first6=Kyra\|last7=Biller\|first7=José\|last8=Brown\|first8=Michael\|last9=Demaerschalk\|first9=Bart M.\|last10=Hoh\|first10=Brian\|last11=Jauch\|first11=Edward C.\|last12=Kidwell\|first12=Chelsea S.\|last13=Leslie-Mazwi\|first13=Thabele M.\|last14=Ovbiagele\|first14=Bruce\|last15=Scott\|first15=Phillip A.\|last16=Sheth\|first16=Kevin N.\|last17=Southerland\|first17=Andrew M.\|last18=Summers\|first18=Deborah V.\|last19=Tirschwell\|first19=David L.\|title=Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association\|journal=Stroke\|volume=50\|issue=12\|year=2019\|issn=0039-2499\|doi=10.1161/STR.0000000000000211}}</ref><ref name="SanossianSaver2006">{{cite journal\|last1=Sanossian\|first1=Nerses\|last2=Saver\|first2=Jeffrey L.\|last3=Liebeskind\|first3=David S.\|last4=Kim\|first4=Doojin\|last5=Razinia\|first5=Tannaz\|last6=Ovbiagele\|first6=Bruce\|title=Achieving Target Cholesterol Goals After Stroke\|journal=Archives of Neurology\|volume=63\|issue=8\|year=2006\|pages=1081\|issn=0003-9942\|doi=10.1001/archneur.63.8.1081}}</ref>

← Older revision		Revision as of 14:25, 20 May 2026
(6 intermediate revisions by the same user not shown)
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	*The dose of [[aspirin]] is usually between 160-300mg daily.<ref name="pmid9174558">{{cite journal \|vauthors= \|title=The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group \|journal=Lancet \|volume=349 \|issue=9065 \|pages=1569–81 \|date=May 1997 \|pmid=9174558 \|doi= \|url=}}</ref>		*The dose of [[aspirin]] is usually between 160-300mg daily.<ref name="pmid9174558">{{cite journal \|vauthors= \|title=The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group \|journal=Lancet \|volume=349 \|issue=9065 \|pages=1569–81 \|date=May 1997 \|pmid=9174558 \|doi= \|url=}}</ref>
	*[[Aspirin\|IV aspirin]] administration within 90 minutes after the start of [[Alteplase\|IV alteplase]] is associated with symptomatic intracranial hemorrhage, for which co administration is discouraged but benefits should be assessed in each individual case.<ref name="PowersRabinstein2019" /><ref name="ZinkstokRoos2012">{{cite journal\|last1=Zinkstok\|first1=Sanne M\|last2=Roos\|first2=Yvo B\|title=Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial\|journal=The Lancet\|volume=380\|issue=9843\|year=2012\|pages=731–737\|issn=01406736\|doi=10.1016/S0140-6736(12)60949-0}}</ref>		*[[Aspirin\|IV aspirin]] administration within 90 minutes after the start of [[Alteplase\|IV alteplase]] is associated with symptomatic intracranial hemorrhage, for which co administration is discouraged but benefits should be assessed in each individual case.<ref name="PowersRabinstein2019" /><ref name="ZinkstokRoos2012">{{cite journal\|last1=Zinkstok\|first1=Sanne M\|last2=Roos\|first2=Yvo B\|title=Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial\|journal=The Lancet\|volume=380\|issue=9843\|year=2012\|pages=731–737\|issn=01406736\|doi=10.1016/S0140-6736(12)60949-0}}</ref>
	*[[Dual antiplatelet therapy]] with [[aspirin~~]] and [[~~clopidogrel~~]] (75 mg/d, with a loading dose of 600mg) may~~ be started within 24 hours ~~after [[symptom]] onset~~ and continued ~~for~~ 21 days in patients with ~~no cardioembolic [[~~ischemic stroke]].<ref name="~~JohnstonEaston2018~~">{{cite journal\|~~last1~~=Johnston\|~~first1~~=~~S. Claiborne~~\|~~last2~~=~~Easton~~\|~~first2~~=~~J. Donald~~\|~~last3~~=~~Farrant~~\|~~first3~~=~~Mary~~\|~~last4~~=~~Barsan~~\|~~first4~~=~~William~~\|~~last5~~=~~Conwit~~\|~~first5~~=~~Robin~~ A.\|~~last6~~=~~Elm~~\|~~first6~~=~~Jordan J.~~\|~~last7~~=~~Kim~~\|~~first7~~=~~Anthony S.~~\|~~last8~~=~~Lindblad~~\|~~first8~~=~~Anne S~~.\|~~last9~~=~~Palesch~~\|~~first9~~=~~Yuko Y.~~\|title=~~Clopidogrel and Aspirin in~~ Acute Ischemic Stroke ~~and High-Risk TIA~~\|journal=~~New England Journal of Medicine~~\|volume=~~379~~\|issue=3\|~~year~~=~~2018~~\|~~pages~~=~~215–225~~\|~~issn~~=~~0028-4793~~\|doi=10.~~1056~~/~~NEJMoa1800410~~}}</ref>		*[[Dual antiplatelet therapy]] (DAPT) with aspirin plus clopidogrel should be started early (ideally within 24 hours) and continued short term (commonly ~21 days) in patients with minor noncardioembolic ischemic stroke or high-risk TIA who did not receive IV thrombolysis, followed by single antiplatelet therapy.<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref><ref name="pmid33724327">{{cite journal \|vauthors=Mendelson SJ, Prabhakaran S \|title=Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review \|journal=JAMA \|volume=325 \|issue=11 \|pages=1088–1098 \|date=March 2021 \|pmid=33724327 \|doi=10.1001/jama.2020.26867 \|url=}}</ref>.
			*In patients with recent stroke/TIA attributable to severe symptomatic intracranial stenosis (Intracranial athrosclerotic diseas i.e ICAD), DAPT for up to 90 days is reasonable<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref>.
	*[[Aspirin]] should not substitute [[Alteplase\|IV alteplase]] or mechanical thrombectomy in patients eligible for these therapies.<ref name="PowersRabinstein2019" />		*[[Aspirin]] should not substitute [[Alteplase\|IV alteplase]] or mechanical thrombectomy in patients eligible for these therapies.<ref name="PowersRabinstein2019" />

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	\|-		\|-
	\| style="padding: 5px 5px; background: #F5F5F5;" \|'''Reperfusion therapy'''		\| style="padding: 5px 5px; background: #F5F5F5;" \|'''Reperfusion therapy'''
	\| style="padding: 5px 5px; background: #F5F5F5;" \|~~[[Tissue plasminogen activator\|'''Tissue plasminogen activator''']] '''~~(~~t-PA~~)~~'''~~		\| style="padding: 5px 5px; background: #F5F5F5;" \|IV thrombolysis (alteplase or tenecteplase); Endovascular thrombectomy (EVT)
	\| style="padding: 5px 5px; background: #F5F5F5;" \|		\| style="padding: 5px 5px; background: #F5F5F5;" \|
	* Recommended within 3-4.5 hours of onset of ischemic stroke in eligible patients by guidelines<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref><ref name="pmid 22315273">{{cite journal\| author=Lansberg MG, O'Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE et al.\| title=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. \| journal=Chest \| year= 2012 \| volume= 141 \| issue= 2 Suppl \| pages= e601S-36S \| pmid= 22315273 \| doi=10.1378/chest.11-2302 \| pmc=3278065 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315273 }} </ref><ref>{{cite web\|url=http://www.aaem.org/em-resources/position-statements/clinical-practice/thrombolytic-therapy \|title=Position Statement on the Use of Intravenous Thrombolytic Therapy in the Treatment of Stroke \|publisher=American Academy of Emergency Medicine \|accessdate=2008-01-25}}</ref> and [[systematic review]]s<ref name="pmid25871671">{{cite journal\| author=Prabhakaran S, Ruff I, Bernstein RA\| title=Acute stroke intervention: a systematic review. \| journal=JAMA \| year= 2015 \| volume= 313 \| issue= 14 \| pages= 1451-62 \| pmid=25871671 \| doi=10.1001/jama.2015.3058 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25871671 }} </ref><ref name="pmid25072528">{{cite journal\| author=Wardlaw JM, Murray V, Berge E, del Zoppo GJ\| title=Thrombolysis for acute ischaemic stroke. \| journal=Cochrane Database Syst Rev \| year= 2014 \| volume= 7 \| issue= \| pages= CD000213 \| pmid=25072528 \| doi=10.1002/14651858.CD000213.pub3 \| pmc=4153726 \| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25072528 }} </ref><ref name="pmid25106063">{{cite journal\| author=Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E et al.\| title=Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. \| journal=Lancet \| year= 2014 \| volume= \| issue= \| pages= \| pmid=25106063 \| doi=10.1016/S0140-6736(14)60584-5 \| pmc= \| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25106063 }} </ref>		* Recommended within 3-4.5 hours of onset of ischemic stroke in eligible patients by guidelines<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref><ref name="pmid 22315273">{{cite journal\| author=Lansberg MG, O'Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE et al.\| title=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. \| journal=Chest \| year= 2012 \| volume= 141 \| issue= 2 Suppl \| pages= e601S-36S \| pmid= 22315273 \| doi=10.1378/chest.11-2302 \| pmc=3278065 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315273 }} </ref><ref>{{cite web\|url=http://www.aaem.org/em-resources/position-statements/clinical-practice/thrombolytic-therapy \|title=Position Statement on the Use of Intravenous Thrombolytic Therapy in the Treatment of Stroke \|publisher=American Academy of Emergency Medicine \|accessdate=2008-01-25}}</ref> and [[systematic review]]s<ref name="pmid25871671">{{cite journal\| author=Prabhakaran S, Ruff I, Bernstein RA\| title=Acute stroke intervention: a systematic review. \| journal=JAMA \| year= 2015 \| volume= 313 \| issue= 14 \| pages= 1451-62 \| pmid=25871671 \| doi=10.1001/jama.2015.3058 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25871671 }} </ref><ref name="pmid25072528">{{cite journal\| author=Wardlaw JM, Murray V, Berge E, del Zoppo GJ\| title=Thrombolysis for acute ischaemic stroke. \| journal=Cochrane Database Syst Rev \| year= 2014 \| volume= 7 \| issue= \| pages= CD000213 \| pmid=25072528 \| doi=10.1002/14651858.CD000213.pub3 \| pmc=4153726 \| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25072528 }} </ref><ref name="pmid25106063">{{cite journal\| author=Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E et al.\| title=Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. \| journal=Lancet \| year= 2014 \| volume= \| issue= \| pages= \| pmid=25106063 \| doi=10.1016/S0140-6736(14)60584-5 \| pmc= \| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25106063 }} </ref>
			* IV alteplase in eligible patients within ≤4.5 h; tenecteplase 0.25 mg/kg IV bolus may be used as an alternative per protocol <ref name="pmid38884324">{{cite journal \|vauthors=Xiong Y, Campbell BC, Schwamm LH, Meng X, Jin A, Parsons MW, Fisher M, Jiang Y, Che F, Wang L, Zhou L, Dai H, Liu X, Pan Y, Duan C, Xu Y, Xu A, Zong L, Tan Z, Ye W, Wang H, Wang Z, Hao M, Cao Z, Wang L, Wu S, Li H, Li Z, Zhao X, Wang Y \|title=Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy \|journal=N Engl J Med \|volume=391 \|issue=3 \|pages=203–212 \|date=July 2024 \|pmid=38884324 \|doi=10.1056/NEJMoa2402980 \|url=}}</ref>; evaluate urgently for EVT in eligible large-vessel occlusion (LVO).
	\| style="padding: 5px 5px; background: #F5F5F5;" \|		\| style="padding: 5px 5px; background: #F5F5F5;" \|
	* None		* None
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	*Oral administration of [[aspirin]] (initial dose is 325 mg) is recommended within 24 to 48 hours after stroke onset in most patients<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref>		*Oral administration of [[aspirin]] (initial dose is 325 mg) is recommended within 24 to 48 hours after stroke onset in most patients<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref>
	*Aspirin is contraindicated in patients with ischemic stroke within 24 hours of t-PA administration<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref>		*Aspirin is contraindicated in patients with ischemic stroke within 24 hours of t-PA administration<ref name="pmid23370205">{{cite journal\| author=Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM et al.\| title=Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. \| journal=Stroke \| year= 2013 \| volume= 44 \| issue= 3 \| pages= 870-947 \| pmid=23370205 \| doi=10.1161/STR.0b013e318284056a \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23370205 }} </ref>
	*DAPT ~~therapy~~ (aspirin ~~and~~ clopidogrel) ~~is recommended~~ for 90 days in patients with symptomatic intracranial ~~large artery disease~~		*DAPT (aspirin + clopidogrel) for up to 90 days is reasonable only for selected patients with recent stroke/TIA attributable to severe symptomatic intracranial stenosis; routine minor stroke/high-risk TIA DAPT is generally shorter (~21 days) followed by SAPT <ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref> <ref name="pmid33724327">{{cite journal \|vauthors=Mendelson SJ, Prabhakaran S \|title=Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review \|journal=JAMA \|volume=325 \|issue=11 \|pages=1088–1098 \|date=March 2021 \|pmid=33724327 \|doi=10.1001/jama.2020.26867 \|url=}}</ref>.
	\| style="padding: 5px 5px; background: #F5F5F5;" \|		\| style="padding: 5px 5px; background: #F5F5F5;" \|
	* Long term therapy with [[clopidogrel]] or aspirin extended release [[dipyridamole]] may be used for secondary prevention of non cardioembolic stroke		* Long term therapy with [[clopidogrel]] or aspirin extended release [[dipyridamole]] may be used for secondary prevention of non cardioembolic stroke

← Older revision		Revision as of 19:59, 18 May 2026
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	*[[Alteplase\|IV alteplase]] is recommended for selected patients who can be treated within 3-4.5 hours of [[ischemic stroke]] [[symptom]] [[onset]] or patient last known well or at [[Baseline (medicine)\|baseline]] state.<ref name="LeesEmberson2016">{{cite journal\|last1=Lees\|first1=Kennedy R.\|last2=Emberson\|first2=Jonathan\|last3=Blackwell\|first3=Lisa\|last4=Bluhmki\|first4=Erich\|last5=Davis\|first5=Stephen M.\|last6=Donnan\|first6=Geoffrey A.\|last7=Grotta\|first7=James C.\|last8=Kaste\|first8=Markku\|last9=von Kummer\|first9=Rüdiger\|last10=Lansberg\|first10=Maarten G.\|last11=Lindley\|first11=Richard I.\|last12=Lyden\|first12=Patrick\|last13=Murray\|first13=Gordon D.\|last14=Sandercock\|first14=Peter A.G.\|last15=Toni\|first15=Danilo\|last16=Toyoda\|first16=Kazunori\|last17=Wardlaw\|first17=Joanna M.\|last18=Whiteley\|first18=William N.\|last19=Baigent\|first19=Colin\|last20=Hacke\|first20=Werner\|last21=Howard\|first21=George\|last22=Marler\|first22=John\|last23=Halls\|first23=Heather\|last24=Holland\|first24=Lisa\|last25=Mathews\|first25=Clare\|last26=Smith\|first26=Samantha\|last27=Wilson\|first27=Kate\|last28=Koga\|first28=Masatoshi\|last29=Albers\|first29=Gregory\|last30=Brott\|first30=Thomas\|last31=Cohen\|first31=Geoffrey\|last32=Koga\|first32=Masatoshi\|last33=Olivot\|first33=Jean Marc\|last34=Parsons\|first34=Mark\|last35=Tilley\|first35=Barbara\|last36=Wahlgren\|first36=Nils\|last37=del Zoppo\|first37=Gregory J\|title=Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes\|journal=Stroke\|volume=47\|issue=9\|year=2016\|pages=2373–2379\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.013644}}</ref><ref name="PowersRabinstein2019" /><ref>{{cite journal\|title=The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial\|journal=The Lancet\|volume=379\|issue=9834\|year=2012\|pages=2352–2363\|issn=01406736\|doi=10.1016/S0140-6736(12)60768-5}}</ref>		*[[Alteplase\|IV alteplase]] is recommended for selected patients who can be treated within 3-4.5 hours of [[ischemic stroke]] [[symptom]] [[onset]] or patient last known well or at [[Baseline (medicine)\|baseline]] state.<ref name="LeesEmberson2016">{{cite journal\|last1=Lees\|first1=Kennedy R.\|last2=Emberson\|first2=Jonathan\|last3=Blackwell\|first3=Lisa\|last4=Bluhmki\|first4=Erich\|last5=Davis\|first5=Stephen M.\|last6=Donnan\|first6=Geoffrey A.\|last7=Grotta\|first7=James C.\|last8=Kaste\|first8=Markku\|last9=von Kummer\|first9=Rüdiger\|last10=Lansberg\|first10=Maarten G.\|last11=Lindley\|first11=Richard I.\|last12=Lyden\|first12=Patrick\|last13=Murray\|first13=Gordon D.\|last14=Sandercock\|first14=Peter A.G.\|last15=Toni\|first15=Danilo\|last16=Toyoda\|first16=Kazunori\|last17=Wardlaw\|first17=Joanna M.\|last18=Whiteley\|first18=William N.\|last19=Baigent\|first19=Colin\|last20=Hacke\|first20=Werner\|last21=Howard\|first21=George\|last22=Marler\|first22=John\|last23=Halls\|first23=Heather\|last24=Holland\|first24=Lisa\|last25=Mathews\|first25=Clare\|last26=Smith\|first26=Samantha\|last27=Wilson\|first27=Kate\|last28=Koga\|first28=Masatoshi\|last29=Albers\|first29=Gregory\|last30=Brott\|first30=Thomas\|last31=Cohen\|first31=Geoffrey\|last32=Koga\|first32=Masatoshi\|last33=Olivot\|first33=Jean Marc\|last34=Parsons\|first34=Mark\|last35=Tilley\|first35=Barbara\|last36=Wahlgren\|first36=Nils\|last37=del Zoppo\|first37=Gregory J\|title=Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes\|journal=Stroke\|volume=47\|issue=9\|year=2016\|pages=2373–2379\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.013644}}</ref><ref name="PowersRabinstein2019" /><ref>{{cite journal\|title=The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial\|journal=The Lancet\|volume=379\|issue=9834\|year=2012\|pages=2352–2363\|issn=01406736\|doi=10.1016/S0140-6736(12)60768-5}}</ref>
			*In imaging-selected patients with wake-up stroke/unknown onset or extended-window presentations, IV thrombolysis may be beneficial when selection criteria are met<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref><ref name="pmid31067369">{{cite journal \|vauthors=Ma H, Campbell BC, Parsons MW, Churilov L, Levi CR, Hsu C, Kleinig TJ, Wijeratne T, Curtze S, Dewey HM, Miteff F, Tsai CH, Lee JT, Phan TG, Mahant N, Sun MC, Krause M, Sturm J, Grimley R, Chen CH, Hu CJ, Wong AA, Field D, Sun Y, Barber PA, Sabet A, Jannes J, Jeng JS, Clissold B, Markus R, Lin CH, Lien LM, Bladin CF, Christensen S, Yassi N, Sharma G, Bivard A, Desmond PM, Yan B, Mitchell PJ, Thijs V, Carey L, Meretoja A, Davis SM, Donnan GA \|title=Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke \|journal=N Engl J Med \|volume=380 \|issue=19 \|pages=1795–1803 \|date=May 2019 \|pmid=31067369 \|doi=10.1056/NEJMoa1813046 \|url=}}</ref>.
	*The [[dose]] of [[Alteplase\|IV alteplase]] is 0.9 mg/kg (maximum dose 90 mg) over 60 min, with 10% of the [[dose]] given as a [[bolus]] over 1 min.<ref name="PowersRabinstein2019" />		*The [[dose]] of [[Alteplase\|IV alteplase]] is 0.9 mg/kg (maximum dose 90 mg) over 60 min, with 10% of the [[dose]] given as a [[bolus]] over 1 min.<ref name="PowersRabinstein2019" />
	*[[Alteplase\|IV alteplase]] should be initiated as soon as possible, having been demonstrated better outcomes the sooner is administered.<ref name="PowersRabinstein2019" />		*[[Alteplase\|IV alteplase]] should be initiated as soon as possible, having been demonstrated better outcomes the sooner is administered.<ref name="PowersRabinstein2019" />
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	====Tenecteplase====		====Tenecteplase====

	*[[Tenecteplase]] ~~may be useful~~ in patients ~~with minor [[neurological]] impairment.~~<ref name="~~HuangCheripelli2015~~">{{cite journal\|~~last1~~=~~Huang~~\|~~first1~~=~~Xuya~~\|~~last2~~=~~Cheripelli~~\|~~first2~~=~~Bharath Kumar~~\|~~last3~~=~~Lloyd~~\|~~first3~~=~~Suzanne M~~\|~~last4~~=~~Kalladka~~\|~~first4~~=~~Dheeraj~~\|~~last5~~=~~Moreton~~\|~~first5~~=~~Fiona Catherine\|last6~~=~~Siddiqui~~\|~~first6~~=~~Aslam\|last7=Ford\|first7=Ian\|last8=Muir\|first8=Keith W~~\|title=~~Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST)~~: ~~a phase 2, randomised, open-label, blinded endpoint study~~\|journal=~~The Lancet Neurology~~\|volume=14\|issue=4\|~~year~~=~~2015~~\|~~pages~~=~~368–376~~\|~~issn~~=~~14744422~~\|doi=10.1016/~~S1474-4422(15)70017-7~~}}</ref>		*[[Tenecteplase]] is a reasonable alternative to alteplase for IV thrombolysis in eligible acute ischemic stroke patients and is administered as a single IV bolus <ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref><ref name="pmid37479410">{{cite journal \|vauthors=Lo BM, Carpenter CR, Ducey S, Gottlieb M, Kaji A, Diercks DB, Diercks DB, Wolf SJ, Anderson JD, Byyny R, Carpenter CR, Friedman B, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Hatten BW, Haukoos JS, Kaji A, Kwok H, Lo BM, Mace SE, Moran M, Promes SB, Shah KH, Shih RD, Silvers SM, Slivinski A, Smith MD, Thiessen ME, Tomaszewski CA, Trent S, Valente JH, Wall SP, Westafer LM, Yu Y, Cantrill SV, Finnell JT, Schulz T, Vandertulip K \|title=Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Ischemic Stroke \|journal=Ann Emerg Med \|volume=82 \|issue=2 \|pages=e17–e64 \|date=August 2023 \|pmid=37479410 \|doi=10.1016/j.annemergmed.2023.03.007 \|url=}}</ref>
	*The dose of [[tenecteplase]] is ~~a single IV [[bolus]] of~~ 0.25-mg/kg (maximum 25 mg).<ref name="~~CampbellMitchell2018~~">{{cite journal\|~~last1~~=~~Campbell~~\|~~first1~~=~~Bruce C.V.~~\|~~last2~~=~~Mitchell~~\|~~first2~~=~~Peter J.~~\|~~last3~~=~~Churilov~~\|~~first3~~=~~Leonid~~\|~~last4~~=~~Yassi~~\|~~first4~~=~~Nawaf~~\|~~last5~~=~~Kleinig~~\|~~first5~~=~~Timothy J~~.\|~~last6~~=Dowling~~\|first6=Richard J.\|last7=~~Yan~~\|first7=Bernard\|last8=~~Bush~~\|first8=Steven J.\|last9=~~Dewey~~\|first9=Helen M.\|last10=~~Thijs~~\|first10=Vincent\|last11=~~Scroop~~\|first11=Rebecca\|last12=~~Simpson~~\|first12=Marion\|last13=~~Brooks~~\|first13=Mark\|last14=~~Asadi~~\|first14=Hamed\|last15=~~Wu~~\|first15=Teddy Y.\|last16=~~Shah~~\|first16=Darshan G.\|last17=~~Wijeratne~~\|first17=Tissa\|last18=~~Ang~~\|first18=Timothy\|last19=~~Miteff~~\|first19=Ferdinand\|last20=~~Levi~~\|first20=Christopher R.\|last21=~~Rodrigues~~\|first21=Edrich\|last22=~~Zhao~~\|first22=Henry\|last23=~~Salvaris~~\|first23=Patrick\|last24=~~Garcia-Esperon~~\|first24=Carlos\|last25=~~Bailey~~\|first25=Peter\|last26=~~Rice~~\|first26=Henry\|last27=~~de Villiers~~\|first27=Laetitia\|last28=~~Brown~~\|first28=Helen\|last29=~~Redmond~~\|first29=Kendal\|last30=~~Leggett~~\|first30=David\|last31=~~Fink~~\|first31=John N.\|last32=~~Collecutt~~\|first32=Wayne\|last33=~~Wong~~\|first33=Andrew A.\|last34=~~Muller~~\|first34=Claire\|last35=~~Coulthard~~\|first35=Alan\|last36=~~Mitchell~~\|first36=Ken\|last37=~~Clouston~~\|first37=John\|last38=~~Mahady~~\|first38=Kate\|last39=~~Field~~\|first39=Deborah\|last40=~~Ma~~\|first40=Henry\|last41=~~Phan~~\|first41=Thanh G.\|last42=~~Chong~~\|first42=Winston\|last43=~~Chandra~~\|first43=Ronil V.\|last44=~~Slater~~\|first44=Lee-Anne\|last45=~~Krause~~\|first45=Martin\|last46=~~Harrington~~\|first46=Timothy J.\|last47=~~Faulder\|~~first47~~=~~Kenneth C.~~\|~~last48~~=~~Steinfort~~\|~~first48~~=~~Brendan S.~~\|~~last49~~=~~Bladin~~\|~~first49~~=~~Christopher F.~~\|~~last50~~=~~Sharma~~\|~~first50~~=~~Gagan~~\|~~last51~~=~~Desmond\|first51=Patricia M~~.\|~~last52~~=~~Parsons\|first52=Mark W~~.~~\|last53~~=~~Donnan~~\|~~first53~~=~~Geoffrey~~ A~~.\|last54=Davis\|first54=Stephen~~ M.\|title=Tenecteplase ~~versus Alteplase before Thrombectomy~~ for Ischemic Stroke\|journal=~~New England Journal of Medicine~~\|volume=~~378~~\|issue=17\|~~year~~=~~2018~~\|~~pages~~=~~1573–1582~~\|~~issn~~=~~0028-4793~~\|doi=10.1056/~~NEJMoa1716405~~}}</ref>		*The dose of [[tenecteplase]] is 0.25 mg/kg IV bolus (maximum 25 mg).<ref name="pmid37479410">{{cite journal \|vauthors=Lo BM, Carpenter CR, Ducey S, Gottlieb M, Kaji A, Diercks DB, Diercks DB, Wolf SJ, Anderson JD, Byyny R, Carpenter CR, Friedman B, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Hatten BW, Haukoos JS, Kaji A, Kwok H, Lo BM, Mace SE, Moran M, Promes SB, Shah KH, Shih RD, Silvers SM, Slivinski A, Smith MD, Thiessen ME, Tomaszewski CA, Trent S, Valente JH, Wall SP, Westafer LM, Yu Y, Cantrill SV, Finnell JT, Schulz T, Vandertulip K \|title=Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Ischemic Stroke \|journal=Ann Emerg Med \|volume=82 \|issue=2 \|pages=e17–e64 \|date=August 2023 \|pmid=37479410 \|doi=10.1016/j.annemergmed.2023.03.007 \|url=}}</ref>
			*Among patients with LVO planned for thrombectomy, tenecteplase (0.25 mg/kg) achieved higher early reperfusion than alteplase (22% vs 10%) and improved 90-day functional outcome (median mRS 2 vs 3) with similar symptomatic ICH (1% vs 1%) in EXTEND-IA TNK.<ref name="pmid29694815">{{cite journal \|vauthors=Campbell BC, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, Yan B, Bush SJ, Dewey HM, Thijs V, Scroop R, Simpson M, Brooks M, Asadi H, Wu TY, Shah DG, Wijeratne T, Ang T, Miteff F, Levi CR, Rodrigues E, Zhao H, Salvaris P, Garcia-Esperon C, Bailey P, Rice H, de Villiers L, Brown H, Redmond K, Leggett D, Fink JN, Collecutt W, Wong AA, Muller C, Coulthard A, Mitchell K, Clouston J, Mahady K, Field D, Ma H, Phan TG, Chong W, Chandra RV, Slater LA, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Bladin CF, Sharma G, Desmond PM, Parsons MW, Donnan GA, Davis SM \|title=Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke \|journal=N Engl J Med \|volume=378 \|issue=17 \|pages=1573–1582 \|date=April 2018 \|pmid=29694815 \|doi=10.1056/NEJMoa1716405 \|url=}}</ref>
			*[[Tenecteplase]] has also shown benefit in selected patients treated 4.5–24 hours after onset when thrombectomy is not available in TRACE-III<ref name="pmid38884324">{{cite journal \|vauthors=Xiong Y, Campbell BC, Schwamm LH, Meng X, Jin A, Parsons MW, Fisher M, Jiang Y, Che F, Wang L, Zhou L, Dai H, Liu X, Pan Y, Duan C, Xu Y, Xu A, Zong L, Tan Z, Ye W, Wang H, Wang Z, Hao M, Cao Z, Wang L, Wu S, Li H, Li Z, Zhao X, Wang Y \|title=Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy \|journal=N Engl J Med \|volume=391 \|issue=3 \|pages=203–212 \|date=July 2024 \|pmid=38884324 \|doi=10.1056/NEJMoa2402980 \|url=}}</ref>.

	====Antiplatelet therapy====		====Antiplatelet therapy====

← Older revision		Revision as of 13:26, 17 May 2026
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	*The usefulness of [[anticoagulants]] such as [[thrombin]] inhibitors ([[dabigatran]]) and [[factor Xa]] inhibitors ([[rivaroxaban]], [[apixaban]], [[edoxaban]]) is not well established in the acute setting of [[stroke]].<ref name="GioiaKate2016">{{cite journal\|last1=Gioia\|first1=Laura C.\|last2=Kate\|first2=Mahesh\|last3=Sivakumar\|first3=Leka\|last4=Hussain\|first4=Dulara\|last5=Kalashyan\|first5=Hayrapet\|last6=Buck\|first6=Brian\|last7=Bussiere\|first7=Miguel\|last8=Jeerakathil\|first8=Thomas\|last9=Shuaib\|first9=Ashfaq\|last10=Emery\|first10=Derek\|last11=Butcher\|first11=Ken\|title=Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation\|journal=Stroke\|volume=47\|issue=7\|year=2016\|pages=1917–1919\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.013491}}</ref>		*The usefulness of [[anticoagulants]] such as [[thrombin]] inhibitors ([[dabigatran]]) and [[factor Xa]] inhibitors ([[rivaroxaban]], [[apixaban]], [[edoxaban]]) is not well established in the acute setting of [[stroke]].<ref name="GioiaKate2016">{{cite journal\|last1=Gioia\|first1=Laura C.\|last2=Kate\|first2=Mahesh\|last3=Sivakumar\|first3=Leka\|last4=Hussain\|first4=Dulara\|last5=Kalashyan\|first5=Hayrapet\|last6=Buck\|first6=Brian\|last7=Bussiere\|first7=Miguel\|last8=Jeerakathil\|first8=Thomas\|last9=Shuaib\|first9=Ashfaq\|last10=Emery\|first10=Derek\|last11=Butcher\|first11=Ken\|title=Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation\|journal=Stroke\|volume=47\|issue=7\|year=2016\|pages=1917–1919\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.013491}}</ref>
	*The use of [[thrombolysis]] via ultrasound waves concomitant to [[Fibrinolysis\|IV fibrinolysis]] is not recommended.<ref name="NacuKvistad2017">{{cite journal\|last1=Nacu\|first1=Aliona\|last2=Kvistad\|first2=Christopher E.\|last3=Naess\|first3=Halvor\|last4=Øygarden\|first4=Halvor\|last5=Logallo\|first5=Nicola\|last6=Assmus\|first6=Jörg\|last7=Waje-Andreassen\|first7=Ulrike\|last8=Kurz\|first8=Kathinka D.\|last9=Neckelmann\|first9=Gesche\|last10=Thomassen\|first10=Lars\|title=NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study)\|journal=Stroke\|volume=48\|issue=2\|year=2017\|pages=335–341\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.014644}}</ref>		*The use of [[thrombolysis]] via ultrasound waves concomitant to [[Fibrinolysis\|IV fibrinolysis]] is not recommended.<ref name="NacuKvistad2017">{{cite journal\|last1=Nacu\|first1=Aliona\|last2=Kvistad\|first2=Christopher E.\|last3=Naess\|first3=Halvor\|last4=Øygarden\|first4=Halvor\|last5=Logallo\|first5=Nicola\|last6=Assmus\|first6=Jörg\|last7=Waje-Andreassen\|first7=Ulrike\|last8=Kurz\|first8=Kathinka D.\|last9=Neckelmann\|first9=Gesche\|last10=Thomassen\|first10=Lars\|title=NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study)\|journal=Stroke\|volume=48\|issue=2\|year=2017\|pages=335–341\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.014644}}</ref>
			*Tenecteplase (0.25 mg/kg IV bolus; max 25 mg) is an accepted alternative to alteplase (0.9 mg/kg; max 90 mg with 10% bolus then 60-minute infusion) in thrombolysis-eligible patients, ideally using an institutional protocol.<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref><ref name="pmid37479410">{{cite journal \|vauthors=Lo BM, Carpenter CR, Ducey S, Gottlieb M, Kaji A, Diercks DB, Diercks DB, Wolf SJ, Anderson JD, Byyny R, Carpenter CR, Friedman B, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Hatten BW, Haukoos JS, Kaji A, Kwok H, Lo BM, Mace SE, Moran M, Promes SB, Shah KH, Shih RD, Silvers SM, Slivinski A, Smith MD, Thiessen ME, Tomaszewski CA, Trent S, Valente JH, Wall SP, Westafer LM, Yu Y, Cantrill SV, Finnell JT, Schulz T, Vandertulip K \|title=Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Ischemic Stroke \|journal=Ann Emerg Med \|volume=82 \|issue=2 \|pages=e17–e64 \|date=August 2023 \|pmid=37479410 \|doi=10.1016/j.annemergmed.2023.03.007 \|url=}}</ref>
	*High-intensity [[statin]] therapy should be initiated in patients younger than 75 with clinical [[Coronary heart disease\|ASCVD]], to achieving a reduction in [[LDL-C]] levels of at least 50%.		*High-intensity [[statin]] therapy should be initiated in patients younger than 75 with clinical [[Coronary heart disease\|ASCVD]], to achieving a reduction in [[LDL-C]] levels of at least 50%.
	*In patients older than 75 years of age with clinical [[Coronary heart disease\|ASCVD]], it is reasonable to initiate moderate or high-intensity [[statin]] therapy after reviewing [[adverse effects]] and [[Drug interaction\|drug interactions]].<ref name="PowersRabinstein2019">{{cite journal\|last1=Powers\|first1=William J.\|last2=Rabinstein\|first2=Alejandro A.\|last3=Ackerson\|first3=Teri\|last4=Adeoye\|first4=Opeolu M.\|last5=Bambakidis\|first5=Nicholas C.\|last6=Becker\|first6=Kyra\|last7=Biller\|first7=José\|last8=Brown\|first8=Michael\|last9=Demaerschalk\|first9=Bart M.\|last10=Hoh\|first10=Brian\|last11=Jauch\|first11=Edward C.\|last12=Kidwell\|first12=Chelsea S.\|last13=Leslie-Mazwi\|first13=Thabele M.\|last14=Ovbiagele\|first14=Bruce\|last15=Scott\|first15=Phillip A.\|last16=Sheth\|first16=Kevin N.\|last17=Southerland\|first17=Andrew M.\|last18=Summers\|first18=Deborah V.\|last19=Tirschwell\|first19=David L.\|title=Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association\|journal=Stroke\|volume=50\|issue=12\|year=2019\|issn=0039-2499\|doi=10.1161/STR.0000000000000211}}</ref><ref name="SanossianSaver2006">{{cite journal\|last1=Sanossian\|first1=Nerses\|last2=Saver\|first2=Jeffrey L.\|last3=Liebeskind\|first3=David S.\|last4=Kim\|first4=Doojin\|last5=Razinia\|first5=Tannaz\|last6=Ovbiagele\|first6=Bruce\|title=Achieving Target Cholesterol Goals After Stroke\|journal=Archives of Neurology\|volume=63\|issue=8\|year=2006\|pages=1081\|issn=0003-9942\|doi=10.1001/archneur.63.8.1081}}</ref>		*In patients older than 75 years of age with clinical [[Coronary heart disease\|ASCVD]], it is reasonable to initiate moderate or high-intensity [[statin]] therapy after reviewing [[adverse effects]] and [[Drug interaction\|drug interactions]].<ref name="PowersRabinstein2019">{{cite journal\|last1=Powers\|first1=William J.\|last2=Rabinstein\|first2=Alejandro A.\|last3=Ackerson\|first3=Teri\|last4=Adeoye\|first4=Opeolu M.\|last5=Bambakidis\|first5=Nicholas C.\|last6=Becker\|first6=Kyra\|last7=Biller\|first7=José\|last8=Brown\|first8=Michael\|last9=Demaerschalk\|first9=Bart M.\|last10=Hoh\|first10=Brian\|last11=Jauch\|first11=Edward C.\|last12=Kidwell\|first12=Chelsea S.\|last13=Leslie-Mazwi\|first13=Thabele M.\|last14=Ovbiagele\|first14=Bruce\|last15=Scott\|first15=Phillip A.\|last16=Sheth\|first16=Kevin N.\|last17=Southerland\|first17=Andrew M.\|last18=Summers\|first18=Deborah V.\|last19=Tirschwell\|first19=David L.\|title=Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association\|journal=Stroke\|volume=50\|issue=12\|year=2019\|issn=0039-2499\|doi=10.1161/STR.0000000000000211}}</ref><ref name="SanossianSaver2006">{{cite journal\|last1=Sanossian\|first1=Nerses\|last2=Saver\|first2=Jeffrey L.\|last3=Liebeskind\|first3=David S.\|last4=Kim\|first4=Doojin\|last5=Razinia\|first5=Tannaz\|last6=Ovbiagele\|first6=Bruce\|title=Achieving Target Cholesterol Goals After Stroke\|journal=Archives of Neurology\|volume=63\|issue=8\|year=2006\|pages=1081\|issn=0003-9942\|doi=10.1001/archneur.63.8.1081}}</ref>