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Stroke Care Best Practices: When Seconds Count

Created Jan 25 2018, 03:20 PM by Lippincott Solutions
  • Joint Commission Resources
  • patient care
  • stroke
  • clinical competency

Fast and effective treatment of stroke can prevent long-term disability and save lives. According to the American College of Cardiology, stroke accounts for 1 of 20 deaths in the U.S. Approximately every 40 seconds, someone experiences a stroke in the U.S., and while death rates due to stroke have declined, stroke has become the leading cause of long-term disability.

The specific treatments recommended depend on the type of stroke. A blood clot obstructing the flow of blood to the brain is an ischemic stroke, while bleeding in or around the brain is a hemorrhagic stroke.

Speed is of utmost importance when treating stroke, which usually involves taking one or more different medications, although some people may also need surgery.

Ischemic stroke treatment

For treating ischemic stroke, a combination of medications to treat the condition and prevent it from happening again is usually recommended. Some of these medications need to be taken immediately and only for a short time, while others may only be started once the stroke has been treated and may need to be taken long-term.

Ischemic strokes can often be treated using injections of a medication called alteplase, which dissolves blood clots and restores blood flow to the brain. This use of clot-busting medication is known as thrombolysis. Alteplase is most effective if started as soon as possible after the stroke occurs. It isn't generally recommended if more than 4.5 hours have passed, as it's not clear how beneficial it is when used after this time.

But before alteplase can be used, it's very important to do a brain scan to confirm a diagnosis of an ischemic stroke. If it's a hemorrhagic stroke, alteplase can make the condition worse.

A small portion of severe ischemic strokes can be treated by an emergency procedure known as thrombectomy, which involves removing blood clots to restore blood flow to the brain. Thrombectomy is only effective at treating ischemic strokes caused by a blood clot in a large artery in the brain.

Most people will be offered a regular dose of aspirin. As well as being a painkiller, aspirin is an antiplatelet, which reduces the chances of another clot forming. Some people may be offered an anticoagulant to help reduce their risk of developing further blood clots in the future. Anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots occurring.

Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban are examples of anticoagulants for long-term use. There are also a number of anticoagulants called heparins that can only be given by injection and are used short-term.

If the level of cholesterol in blood is too high, patients will be advised to take a statin. Statins reduce the level of cholesterol in the blood by blocking a chemical enzyme in the liver that produces cholesterol, and may help reduce the risk of stroke.

Some ischemic strokes are caused by narrowing of an artery in the neck called the carotid artery, which carries blood to the brain. The narrowing, known as carotid stenosis, is caused by a build-up of fatty plaques. If the carotid stenosis is severe, surgery may be performed to unblock the artery. This is done using a surgical technique called a carotid endarterectomy. It involves the surgeon making an incision in the neck to open up the carotid artery and remove the fatty deposits.

Hemorrhagic stroke treatment

As with ischemic strokes, some people who have had a hemorrhagic stroke will also be offered medication to lower their blood pressure and prevent further strokes.

Occasionally, emergency surgery may be needed to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy.

During a craniotomy, a section of the skull is cut away to allow the surgeon access to the cause of the bleeding. The surgeon will repair any damaged blood vessels and ensure there are no blood clots present that may restrict the blood flow to the brain. After the bleeding has been stopped, the piece of bone removed from the skull is replaced, often by an artificial metal plate.

Surgery can also be carried out to treat a complication of hemorrhagic strokes called hydrocephalus. This is where damage resulting from a stroke causes cerebrospinal fluid to build up in the cavities (ventricles) of the brain, causing symptoms such as headaches, sickness, drowsiness, vomiting, and loss of balance. Hydrocephalus can be treated by surgically placing an artificial tube called a shunt into the brain to allow the fluid to drain properly.

Once a patient is released from acute care, most stroke sufferers will need to spend some time doing rehabilitation. Stroke experts have defined the standards that define good stroke care, including:

  • Rapid response to a call for suspected stroke
  • Prompt transfer to a hospital providing specialist care
  • Urgent brain scan –CT scan or MRI scan undertaken as soon as possible
  • Immediate access to a high-quality stroke unit
  • Early multidisciplinary assessment, including swallowing screening
  • Specialized stroke rehabilitation
  • Planned transfer of care from hospital to community and longer-term support.

Additional Resources

For additional information to enhance competency of your organization’s stroke care, let Lippincott Professional Development Collection help.  Our growing institutional library of over 370 online courses includes a program set on Stroke Disease-Specific Care that we co-developed with Joint Commission Resources. 

With 20 CE-accredited courses, featured topics include ischemic and hemorrhagic stroke pathophysiology and treatment, prevention, rehabilitation and more.  Click HERE for a free preview and to learn more.