INTRODUCTION

Stroke is the leading cause of disability worldwide and remains a major cause of death among Filipinos. Despite being the most common neurological disease, wide variations in management persist among clinicians. This CPG aims to provide evidence-based recommendations for the diagnosis and management of acute stroke.

METHODS

A systematic synthesis of evidence was conducted to address the diagnosis and management of both acute hemorrhagic and ischemic stroke. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was followed. The process included: (1) generation of critical questions and outcomes (2) retrieval of current and relevant evidence, (3) synthesis and appraisal of the evidence base, (4) formulation of draft recommendations, (5) deliberation by a multi-sectoral stakeholder panel on feasibility, values and preferences to assess the strength of recommendations and (6) planning for dissemination, implementation, impact evaluation and updating.

RESULTS

Sixteen clinical questions were addressed leading to 21 recommendations. Most were strong recommendations supported by moderate to high certainty of evidence. The recommendations span the spectrum of acute stroke care, including early diagnosis with imaging, admission to stroke units, reperfusion therapies, surgical options, prevention of complications and the role of adjunctive treatments.

CONCLUSION

The recommendations in this CPG are intended to guide clinicians and other stakeholders in the diagnosis and management of acute stroke. They are meant to supplement, not replace, the sound clinical judgment of healthcare providers.

Ischemic Stroke ; Cerebral Hemorrhage ; Hemorrhage ; Hemorrhagic Stroke

INTRODUCTION

Stroke is the leading cause of disability worldwide and remains a major cause of death among Filipinos. Despite being the most common neurological disease, wide variations in management persist among clinicians. This CPG aims to provide evidence-based recommendations for the diagnosis and management of acute stroke.

METHODS

A systematic synthesis of evidence was conducted to address the diagnosis and management of both acute hemorrhagic and ischemic stroke. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was followed. The process included: (1) generation of critical questions and outcomes (2) retrieval of current and relevant evidence, (3) synthesis and appraisal of the evidence base, (4) formulation of draft recommendations, (5) deliberation by a multi-sectoral stakeholder panel on feasibility, values and preferences to assess the strength of recommendations and (6) planning for dissemination, implementation, impact evaluation and updating.

RESULTS

Sixteen clinical questions were addressed leading to 21 recommendations. Most were strong recommendations supported by moderate to high certainty of evidence. The recommendations span the spectrum of acute stroke care, including early diagnosis with imaging, admission to stroke units, reperfusion therapies, surgical options, prevention of complications and the role of adjunctive treatments.

CONCLUSION

The recommendations in this CPG are intended to guide clinicians and other stakeholders in the diagnosis and management of acute stroke. They are meant to supplement, not replace, the sound clinical judgment of healthcare providers.

Ischemic Stroke ; Cerebral Hemorrhage ; Hemorrhage ; Hemorrhagic Stroke

BACKGROUND

Recombinant Tissue Plasminogen Activator therapy has been recommended as the standard treatment for acute ischemic stroke. The experience in the Philippines is still limited.

OBJECTIVE

We evaluated the clinical profile and outcome of our acute ischemic stroke patients who underwent thrombolysis.

PATIENTS AND METHODS

Ten cases from a retrospectively collected database of patients with acute ischemic stroke who presented within 3 hour of onset were screened under the Brain Attack Team Program. Those eligible were treated with thrombolysis with recombinant tissue plasminogen activator (rt-PA) at 0.9 mg/kg, and or bridging therapy with intravenous and intraarterial for those beyond the therapeutic window. General and neurological examinations together with the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) were recorded prior to and after the treatment at 1 hour, 24 hour, on discharge. Hemorrhagic brain lesion and death within discharge were also recorded.

RESULTS

The mean pretreatment NIHSS score was 18 and most of the patients had anterior circulation infarction. The mean door-to-treatment time was 170 min (ranged 60-400 min). lntracerebral hemorrhage was detected in three cases, and one was fatal.

CONCLUSION

Thrombolytic therapy can be given in patients with acute stroke without down-titrating the dose in our population. The risk of hemorrhagic brain lesion is not much higher compared to other studies.

Human ; Female ; Humans ; ; Tissue Plasminogen Activator ; ; Stroke ; ; Brain Ischemia ; ; Philippines ; ; Infarction ; ; Time-to-treatment ; ; Thrombolytic Therapy ; ; Cerebral Hemorrhage ; ; Neurologic Examination ; ; National Institutes Of Health (u.s.) ; ; Brain ; ; Retrospective Studies