Acute Ischemic Stroke Management

Patient Assessment and Initial Management

The American Heart Association recommends that patients with acute ischemic stroke should receive comprehensive stroke unit care, which reduces mortality and improves functional outcomes 8
The American College of Cardiology recommends maintaining blood pressure <180/105 mmHg for at least 24 hours post-thrombolysis, with monitoring every 15 minutes for 2 hours, then every 30 minutes for 6 hours, then hourly for 16 hours 3, 1
Patients with acute ischemic stroke should undergo neurological assessments using NIHSS every 15 minutes for 2 hours, then every 30 minutes for 6 hours, then hourly for 16 hours, to monitor for hemorrhagic transformation, cerebral edema, and seizures 3
The American Stroke Association recommends keeping patients NPO until a formal swallowing screen is completed, to prevent aspiration pneumonia 7, 2

The American College of Chest Physicians recommends initiating dual antiplatelet therapy with aspirin and clopidogrel for 21 days after minor-to-moderate stroke, followed by single antiplatelet therapy 4
The American Heart Association recommends continuing atorvastatin at a high-intensity dose (80 mg daily) for secondary prevention, regardless of baseline cholesterol 5
Patients with diabetes should have their glycemic control optimized with a target HbA1c <7%, according to the American Diabetes Association 2
The American College of Cardiology recommends restarting antihypertensive therapy after the first 24 hours post-thrombolysis, with a target blood pressure <140/90 mmHg 3

Patients should be monitored for neurological complications such as hemorrhagic transformation, cerebral edema, and seizures, with urgent repeat CT if neurological deterioration occurs 5, 6
The American Stroke Association recommends monitoring for medical complications such as aspiration pneumonia, urinary tract infection, deep vein thrombosis, and pressure ulcers 7, 5
Patients should be educated on stroke warning signs (FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 911) and the importance of medication adherence, according to the American Heart Association 9, 5