Acute Ischemic Stroke: A Case Study

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Bansal, S., Sangha, K.S., Khatri, P. (2013). Drug treatment of acute ischemic stroke. American Journal of Cardiovascular Drugs, 13(1). doi:10.1007/s40256-013-0007-6
An acute ischemic stroke occurs when a blood vessel is blocked leading to irreversible brain damage and consequent focal neurologic deficits. Drug remedy of acute ischemic stroke includes intravenous thrombolysis with alteplase (recombinant tissue plasminogen activator). Intravenous alteplase stimulates thrombolysis by hydrolyzing plasminogen to form the proteolytic enzyme plasmin. Plasmin aims the blood clot with narrow systemic thrombolytic consequences. For successful treatment, the drug should be administered within a short period to appropriate patients. In chosen patients,
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Annually 780000 people in the USA suffer a new or repeated stroke, which transforms to one stroke attack every 40 (Elissa, Krass & Bajorek,2012 ). Intravenous tissue plasminogen activator (tPA) is the only evidence-based treatment for acute ischaemic stroke. However, the use is limited. There were certain barriers identified for low utilization of tPA, and they were broadly classified as “Pre- admission” and “Post-admission” barriers. Pre-admission barriers include decisions made in patient care by patient or paramedics before bringing the patient to the hospital. Late arrival to the hospital is a major factor to narrow the administration of tPA due to the limited time window. In Australia, 61% of patients are ineligible to receive tPA due to late arrival to hospital (Elissa, Krass & Bajorek,2012). Post-admission barriers include the delay in evaluation and treatment, shortage of facilities and indecision to consider risks vs. benefits of tPA. According to Elissa, Krass & Bajorek (2012) the most important random controlled trials are ECASSIII and NINDS( National Institute of Neurological Disorders and Stroke) that give evidence on the usage of IV tPA. Research indicates that, with tPA administration, there is a decrease in disability at 90days from a stroke. Efforts are needed to focus the barriers on using and encouraging applicable execution of the stroke treatment guidelines to enhance the…show more content…
Research indicated that patients receiving tissue- type plasminogen activator enhanced to positive outcomes (Schrock & Lum,2014). For patients with acute ischemic stroke, the American Heart Association encourages door to needle time of 60 minutes or less treated with IV tPA. However, this frame is only achieved in 30% of the patients(Schrock and Lum 2014).Diagnostic examinations inhibit the achievement of the door to needle time.Completing an ECG before doing the head CT increases the time by six minutes.Obtaining a chest radiograph before head CT increases the time by 13 minutes.Studies reveal that the diagnostic tests that are ordered will impact the door to needle time of 60 minutes or less in patients with acute ischemic stroke.Speedy treatment with IV Tpa decreases patient outcomes such as morbidity and mortality and also rates of symptomatic intracranial
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