From the Guidelines
The immediate management of a post-stroke patient requires rapid assessment and intervention within the first hours to days following the event, with a focus on stabilizing vital functions, determining stroke type, and implementing appropriate reperfusion therapy if eligible, as recommended by the most recent guidelines 1. The initial care should prioritize the patient's airway, breathing, and circulation, with careful management of blood pressure, glucose levels, and temperature.
- Blood pressure should be maintained below 180/105 mm Hg for at least the first 24 h after acute reperfusion treatment, as suggested by the guidelines 1.
- Administration of aspirin is recommended within 24–48 h after stroke onset, with a dose of 300mg initially, followed by 75-100mg daily maintenance, unless contraindicated 1.
- Gradual early mobilization should be encouraged, with patients who have limited mobility treated with thigh-high intermittent pneumatic compression devices (IPC), if available, to prevent deep vein thrombosis 1.
- Body temperature should be monitored, and fever (temperature > 38°C) should be treated, with sources of fever investigated and treated promptly 1. The comprehensive approach to post-stroke care should also include dysphagia screening before oral intake, prevention of complications through proper positioning and skin care, and establishment of a plan for rehabilitation and secondary prevention, as outlined in the guidelines 1. In patients with acute ischemic stroke, intravenous administration of rtPA (0.9 mg/kg; maximum 90 mg) is strongly recommended for treatment of carefully selected patients who can receive the medication within 3 hours of onset of stroke, as stated in the earlier guidelines 1. However, the most recent guidelines 1 provide a more comprehensive and updated approach to post-stroke management, emphasizing the importance of rapid assessment, appropriate reperfusion therapy, and careful management of blood pressure, glucose levels, and temperature.
From the Research
Immediate Management and Treatment Plan for Post-Stroke Patients
The immediate management and treatment plan for a patient post-stroke involves several key components, including:
- Antiplatelet therapy to prevent further stroke or death
- Management of stroke risk factors, such as high blood pressure and atrial fibrillation
- Rehabilitation and supportive care to improve functional outcomes
Antiplatelet Therapy
Antiplatelet therapy with aspirin is a crucial component of post-stroke management, as it has been shown to reduce the risk of recurrent ischemic stroke and death 2, 3. The optimal dose of aspirin for post-stroke management is between 160-325 mg per day 4. Aspirin should be started as soon as possible after stroke onset, ideally within 48 hours 2.
Other Antiplatelet Agents
Other antiplatelet agents, such as clopidogrel and ticagrelor, may also be used in post-stroke management, particularly in patients with certain stroke subtypes or those who are at high risk of recurrent stroke 5. Dual antiplatelet therapy with aspirin and another agent may be considered in certain cases, but it is associated with an increased risk of bleeding 5.
Individualized Treatment Approach
The specific antiplatelet regimen should be individualized based on the patient's stroke characteristics, time from symptom onset, and patient-specific predisposition to develop hemorrhagic complications 5. Other medications, such as statins and angiotensin receptor blockers, may also be used to reduce stroke risk and improve outcomes 6.
Key Considerations
Key considerations in post-stroke management include:
- Early initiation of antiplatelet therapy to reduce the risk of recurrent stroke and death
- Individualized treatment approach based on patient-specific factors
- Monitoring for bleeding complications and adjusting treatment as needed
- Rehabilitation and supportive care to improve functional outcomes and reduce disability