title: Controversies in acute stroke treatment.
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.
authors.affiliation: Carle Hospital Stroke Team, Urbana, Illinois, USA.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Brethour
authors.forename: Karin V
authors.initials: KV
authors.lastname: Nyström
authors.forename: Sandra
authors.initials: S
authors.lastname: Broughton
authors.forename: Terri E
authors.initials: TE
authors.lastname: Kiernan
authors.forename: Amy
authors.initials: A
authors.lastname: Perez
authors.forename: Diane
authors.initials: D
authors.lastname: Handler
authors.forename: Victoria
authors.initials: V
authors.lastname: Swatzell
authors.forename: Joanna Jiehong
authors.initials: JJ
authors.lastname: Yang
authors.forename: Michele
authors.initials: M
authors.lastname: Starr
authors.forename: Karen B
authors.initials: KB
authors.lastname: Seagraves
authors.forename: Fern
authors.initials: F
authors.lastname: Cudlip
authors.forename: Sharon
authors.initials: S
authors.lastname: Biby
authors.forename: Susan
authors.initials: S
authors.lastname: Tocco
authors.forename: Pauline
authors.initials: P
authors.lastname: Owens
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
mesh_terms: D000208:Acute Disease; D001794:Blood Pressure; D004496:Education, Continuing; D006801:Humans; D007262:Infusions, Intravenous; D009722:Nurse Practitioners; D024802:Nurse's Role; D020521:Stroke / Q000188:drug therapy* / Q000451:nursing / Q000503:physiopathology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D010959:Tissue Plasminogen Activator