Regarding stroke management

A. All patients with suspected acute stroke should receive emergency brain imaging before initiating any specific therapy.

B. Noncontrast CT of the brain is not effective to exclude ICH.

C. The assessment of blood glucose must precede the initiation of IV alteplase.

D. Baseline ECG is recommended before thrombolysis.

E. Supplemental oxygen should be provided to maintain oxygen saturation >94%.

F. Supplemental oxygen is recommended in nonhypoxic patients with AIS.

G. In patients eligible for thrombolysis, the treatment should be initiated as quickly as possible.

H. Thrombolysis should not be delayed for hematologic or coagulation testing.

I. IV alteplase should not be administered to patients who have received a full treatment dose of Enoxaparin within the previous 24 hours.

Answers

A. True. All patients with suspected acute stroke should receive emergency brain imaging evaluation on first arrival to a hospital before initiating any specific therapy to treat acute ischemic stroke.

B. False. Noncontrast CT (NCCT) is effective to exclude ICH before IV alteplase administration.

C. True. Only the assessment of blood glucose must precede the initiation of IV alteplase in all patients.

D. True. Baseline electrocardiographic assessment is recommended in patients presenting with acute ischemic stroke but should not delay initiation of IV alteplase.

E. True. Supplemental oxygen should be provided to maintain oxygen saturation >94%.

F. False. Supplemental oxygen is not recommended in nonhypoxic patients with AIS.

G. True. In patients eligible for IV alteplase, benefit of therapy is time dependent, and treatment should be initiated as quickly as possible.

H. True. Given the extremely low risk of unsuspected abnormal platelet counts or coagulation studies in a population, it is reasonable that urgent IV alteplase treatment not be delayed while waiting for hematologic or coagulation testing if there is no reason to suspect an abnormal test.

I. True. IV alteplase should not be administered to patients who have received a full treatment dose of low-molecular-weight heparin (LMWH) within the previous 24 hours.

Notes

• IV alteplase (0.9 mg/kg, maximum dose 90 mg over 60 minutes with initial 10% of dose given as bolus over 1 minute) is recommended for selected patients who can be treated within 4.5 hours of ischemic stroke symptom onset or patient last known well or at baseline state.