From the Research
The 90-day stroke mortality rate can be significantly reduced with immediate and appropriate treatment, including administration of tissue plasminogen activator (tPA) within 4.5 hours of symptom onset for ischemic strokes, and blood pressure control for hemorrhagic strokes, as well as post-stroke care with antiplatelet therapy, statins, blood pressure management, and early rehabilitation, as supported by recent studies such as 1 and 2. To reduce 90-day mortality, it is essential to consider the type of stroke, severity, patient age, and quality of care.
- For ischemic strokes, administration of tPA within 4.5 hours of symptom onset is crucial, at a dose of 0.9 mg/kg (maximum 90 mg) with 10% given as bolus and the remainder over 60 minutes.
- For hemorrhagic strokes, blood pressure control is critical, often using labetalol (10-20 mg IV) or nicardipine (5 mg/hr IV, titrated).
- Post-stroke care should include antiplatelet therapy (aspirin 81-325 mg daily), statins (atorvastatin 40-80 mg daily), blood pressure management (target <130/80 mmHg), and early rehabilitation.
- Modifiable risk factors that significantly impact 90-day mortality include hypertension, diabetes control, smoking cessation, and atrial fibrillation management (often with anticoagulants like apixaban 5 mg twice daily), as discussed in 3 and 4. The mortality risk is highest in the first week post-stroke and gradually decreases, with complications like pneumonia, recurrent stroke, and cardiac events contributing significantly to deaths within this critical 90-day window, highlighting the importance of aggressive management and prevention strategies, as outlined in 5 and 2.