Controversies in acute stroke treatment

Mary K. Brethour, Karin V. Nyström, Sandra Broughton, Terri E. Kiernan, Amy Perez, Diane Handler, Victoria Swatzell, Joanna Jiehong Yang, Michele Starr, Karen B. Seagraves, Fern Cudlip, Sharon Biby, Susan Tocco, Pauline Owens, Anne Alexandrov

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

The evidence base supporting the management of patients with acute stroke is evolving at a rapid rate, as new methods that aim to reduce disability and death from stroke are explored. Intravenous tissue plasminogen activator remains the only treatment shown in numerous studies to reduce disability 3 months after stroke with no increase in the risk of death and a relatively minor rate of symptomatic intracerebral hemorrhage complications. Despite these findings, health care providers have been slow to adopt this evidence-based treatment, which results in many patients experiencing disability caused by stroke. Numerous controversies exist related to the management of patients with acute stroke, including the use of tissue plasminogen activator, positioning and early mobility, blood pressure lowering in acute intracerebral hemorrhage, and even the use of innovative advanced practice nurse-led stroke treatment teams, with varying amounts of evidence available to provide direction. This article explores controversies associated with both approved and evolving treatments for ischemic and hemorrhagic stroke and makes recommendations for practice on the basis of the body of existing evidence, with an aim to improve the delivery of acute stroke treatment.

Original languageEnglish (US)
Pages (from-to)158-172
Number of pages15
JournalAACN Advanced Critical Care
Volume23
Issue number2
DOIs
StatePublished - Apr 1 2012

Fingerprint

Stroke
Cerebral Hemorrhage
Tissue Plasminogen Activator
Therapeutics
Health Personnel
Nurses
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Emergency Medicine
  • Critical Care

Cite this

Brethour, M. K., Nyström, K. V., Broughton, S., Kiernan, T. E., Perez, A., Handler, D., ... Alexandrov, A. (2012). Controversies in acute stroke treatment. AACN Advanced Critical Care, 23(2), 158-172. https://doi.org/10.1097/NCI.0b013e31824fe1b6

Controversies in acute stroke treatment. / Brethour, Mary K.; Nyström, Karin V.; Broughton, Sandra; Kiernan, Terri E.; Perez, Amy; Handler, Diane; Swatzell, Victoria; Yang, Joanna Jiehong; Starr, Michele; Seagraves, Karen B.; Cudlip, Fern; Biby, Sharon; Tocco, Susan; Owens, Pauline; Alexandrov, Anne.

In: AACN Advanced Critical Care, Vol. 23, No. 2, 01.04.2012, p. 158-172.

Research output: Contribution to journalArticle

Brethour, MK, Nyström, KV, Broughton, S, Kiernan, TE, Perez, A, Handler, D, Swatzell, V, Yang, JJ, Starr, M, Seagraves, KB, Cudlip, F, Biby, S, Tocco, S, Owens, P & Alexandrov, A 2012, 'Controversies in acute stroke treatment', AACN Advanced Critical Care, vol. 23, no. 2, pp. 158-172. https://doi.org/10.1097/NCI.0b013e31824fe1b6
Brethour MK, Nyström KV, Broughton S, Kiernan TE, Perez A, Handler D et al. Controversies in acute stroke treatment. AACN Advanced Critical Care. 2012 Apr 1;23(2):158-172. https://doi.org/10.1097/NCI.0b013e31824fe1b6
Brethour, Mary K. ; Nyström, Karin V. ; Broughton, Sandra ; Kiernan, Terri E. ; Perez, Amy ; Handler, Diane ; Swatzell, Victoria ; Yang, Joanna Jiehong ; Starr, Michele ; Seagraves, Karen B. ; Cudlip, Fern ; Biby, Sharon ; Tocco, Susan ; Owens, Pauline ; Alexandrov, Anne. / Controversies in acute stroke treatment. In: AACN Advanced Critical Care. 2012 ; Vol. 23, No. 2. pp. 158-172.
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