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GUÍAS CLÍNICAS


01 febrero 2017

STROKE. Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Eric E. Smith, Gustavo Saposnik, Geert Jan Biessels, Fergus N. Doubal, Myriam Fornage, Philip B. Gorelick, Steven M. Greenberg, Randall T. Higashida, Scott E. Kasner and Sudha Seshadri

Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians.

01 febrero 2017

STROKE. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Amytis Towfighi, Bruce Ovbiagele, Nada El Husseini, Maree L. Hackett, Ricardo E. Jorge, Brett M. Kissela, Pamela H. Mitchell, Lesli E. Skolarus, Mary A. Whooley and Linda S. Williams

Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. Individuals with PSD are at a higher risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council’s Scientific Statements Oversight Committee and the American Heart Association’s Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice.

07 junio 2016

CIRCULATION. AHA/WHF SCIENTIFIC STATEMENT. The Heart of 25 by 25: Achieving the Goal of Reducing Global and Regional Premature Deaths From Cardiovascular Diseases and Stroke. A Modeling Study From the American Heart Association and World Heart Federation

Ralph L. Sacco, Gregory A. Roth, K. Srinath Reddy, Donna K. Arnett, Ruth Bonita, Thomas A. Gaziano, Paul A. Heidenreich, Mark D. Huffman, Bongani M. Mayosi, Shanthi Mendis, Christopher J.L. Murray, Pablo Perel, Daniel J. Piñeiro, Sidney C. Smith, Kathryn A. Taubert, David A. Wood, Dong Zhao and William A. Zoghbi

Abstract: In 2011, the United Nations set key targets to reach by 2025 to reduce the risk of premature noncommunicable disease death by 25% by 2025. With cardiovascular disease being the largest contributor to global mortality, accounting for nearly half of the 36 million annual noncommunicable disease deaths, achieving the 2025 goal requires that cardiovascular disease and its risk factors be aggressively addressed.

04 mayo 2016

STROKE. AHA/ASA Guideline Guidelines. for Adult Stroke Rehabilitation and Recovery. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Carolee J. Winstein, PhD, PT, Chair; Joel Stein, MD, Vice Chair; Ross Arena, PhD, PT, FAHA; Barbara Bates, MD, MBA; Leora R. Cherney, PhD; Steven C. Cramer, MD; Frank Deruyter, PhD; Janice J. Eng, PhD, BSc; Beth Fisher, PhD, PT; Richard L. Harvey, MD; Catherine E. Lang, PhD, PT; Marilyn MacKay-Lyons, BSc, MScPT, PhD; Kenneth J. Ottenbacher, PhD, OTR; Sue Pugh, MSN, RN, CNS-BC, CRRN, CNRN, FAHA; Mathew J. Reeves, PhD, DVM, FAHA; Lorie G. Richards, PhD, OTR/L; William Stiers, PhD, ABPP (RP); Richard D. Zorowitz, MD; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research

Purpose: The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke.

22 diciembre 2015

STROKE. AHA/ASA Scientific Statement. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Bart M. Demaerschalk, MD, MSc, FRCPC, FAHA, Chair; Dawn O. Kleindorfer, MD, FAHA, Vice-Chair; Opeolu M. Adeoye, MD, MS, FAHA; Andrew M. Demchuk, MD; Jennifer E. Fugate, DO; James C. Grotta, MD; Alexander A. Khalessi, MD, MS, FAHA; Elad I. Levy, MD, MBA, FAHA; Yuko Y. Palesch, PhD; Shyam Prabhakaran, MD, MS, FAHA; Gustavo Saposnik, MD, MSc, FAHA; Jeffrey L. Saver, MD, FAHA; Eric E. Smith, MD, MPH, FAHA; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention

Purpose: To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke.

28 octubre 2014

STROKE. AHA/ASA Guideline. Guidelines for the Primary Prevention of Stroke. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

James F. Meschia, MD, FAHA, Chair; Cheryl Bushnell, MD, MHS, FAHA, Vice-Chair; Bernadette Boden-Albala, MPH, DrPH; Lynne T. Braun, PhD, CNP, FAHA; Dawn M. Bravata, MD; Seemant Chaturvedi, MD, FAHA; Mark A. Creager, MD, FAHA; Robert H. Eckel, MD, FAHA; Mitchell S.V. Elkind, MD, MS, FAAN, FAHA; Myriam Fornage, PhD, FAHA; Larry B. Goldstein, MD, FAHA; Steven M. Greenberg, MD, PhD, FAHA; Susanna E. Horvath, MD; Costantino Iadecola, MD; Edward C. Jauch, MD, MS, FAHA; Wesley S. Moore, MD, FAHA; John A. Wilson, MD; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Functional Genomics and Translational Biology, and Council on Hypertension

Abstract: The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

01 noviembre 2015

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS)

Joan C. Wojak, MD, Todd A. Abruzzo, MD, Jacqueline A. Bello, MD, Kristine Ann Blackham, MD, Joshua A. Hirsch, MD, Mahesh V. Jayaraman, MD, Sean R. Dariushnia, MD, Philip M. Meyers, MD, Mehran Midia, MD, FRCPC, Eric J. Russell, MD, T. Gregory Walker, MD, Boris Nikolic, MD, MBA

Preamble: The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from both the private and academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid broad expert constituency of the subject matter under consideration for standards production.

28 mayo 2015

STROKE. AHA/ASA Guideline. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

J. Claude Hemphill III, MD, MAS, FAHA, Chair; Steven M. Greenberg, MD, PhD, Vice-Chair; Craig S. Anderson, MD, PhD; Kyra Becker, MD, FAHA; Bernard R. Bendok, MD, MS, FAHA; Mary Cushman, MD, MSc, FAHA; Gordon L. Fung, MD, MPH, PhD, FAHA; Joshua N. Goldstein, MD, PhD, FAHA; R. Loch Macdonald, MD, PhD, FRCS; Pamela H. Mitchell, RN, PhD, FAHA; Phillip A. Scott, MD, FAHA; Magdy H. Selim, MD, PhD; Daniel Woo, MD, MS; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, and Council on Clinical Cardiology

Purpose: The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage.

22 julio 2010

STROKE. AHA/ASA Guideline. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Lewis B. Morgenstern, MD, FAHA, FAAN, Chair; J. Claude Hemphill III, MD, MAS, FAAN, Vice-Chair; Craig Anderson, MBBS, PhD, FRACP; Kyra Becker, MD; Joseph P. Broderick, MD, FAHA; E. Sander Connolly Jr, MD, FAHA; Steven M. Greenberg, MD, PhD, FAHA, FAAN; James N. Huang, MD; R. Loch Macdonald, MD, PhD; Steven R. Messé, MD, FAHA; Pamela H. Mitchell, RN, PhD, FAHA, FAAN; Magdy Selim, MD, PhD, FAHA; Rafael J. Tamargo, MD; on behalf of the American Heart Association Stroke Council and Council on Cardiovascular Nursing

Purpose: The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage.

08 octubre 2015

STROKE. Special Report. Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis

Anne L. Abbott, PhD, MBBS, FRACP; Kosmas I. Paraskevas, MD, PhD; Stavros K. Kakkos, MD, PhD; Jonathan Golledge, MB, BChir, BA, MA, MChir; Hans-Henning Eckstein, MD, PhD; Larry J. Diaz-Sandoval, MD; Longxing Cao, MD, PhD; Qiang Fu, MD, PhD; Tissa Wijeratne, MD, FRACP; Thomas W. Leung, MD; Miguel Montero-Baker, MD; Byung-Chul Lee, MD, PhD; Sabine Pircher, BNutrDiet, MPH; Marije Bosch, PhD; Martine Dennekamp, PhD, MSc; Peter Ringleb, MD, PhD

Background and Purpose: We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis.

29 junio 2015

STROKE. AHA/ASA Guideline. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

William J. Powers, MD, FAHA, Chair; Colin P. Derdeyn, MD, FAHA, Vice Chair; José Biller, MD, FAHA; Christopher S. Coffey, PhD; Brian L. Hoh, MD, FAHA; Edward C. Jauch, MD, MS, FAHA; Karen C. Johnston, MD, MSc; S. Claiborne Johnston, MD, PhD, FAHA; Alexander A. Khalessi, MD, MS, FAHA; Chelsea S. Kidwell, MD, FAHA; James F. Meschia, MD, FAHA; Bruce Ovbiagele, MD, MSc, MAS, FAHA; Dileep R. Yavagal, MD, MBBS; on behalf of the American Heart Association Stroke Council

Purpose: The aim of this guideline is to provide a focused update of the current recommendations for the endovascular treatment of acute ischemic stroke. When there is overlap, the recommendations made here supersede those of previous guidelines.

18 junio 2015

STROKE. AHA/ASA Guideline. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

B. Gregory Thompson, MD, Chair; Robert D. Brown Jr, MD, MPH, FAHA, Co-Chair; Sepideh Amin-Hanjani, MD, FAHA; Joseph P. Broderick, MD, FAHA; Kevin M. Cockroft, MD, MSc, FAHA; E. Sander Connolly Jr, MD, FAHA; Gary R. Duckwiler, MD, FAHA; Catherine C. Harris, PhD, RN, MBA, CRNP; Virginia J. Howard, PhD, MSPH, FAHA; S. Claiborne (Clay) Johnston, MD, PhD; Philip M. Meyers, MD, FAHA; Andrew Molyneux, MD; Christopher S. Ogilvy, MD; Andrew J. Ringer, MD; James Torner, PhD, MS, FAHA; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention

Purpose: The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms.

28 mayo 2015

STROKE. AHA/ASA Guideline. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

J. Claude Hemphill III, MD, MAS, FAHA, Chair; Steven M. Greenberg, MD, PhD, Vice-Chair; Craig S. Anderson, MD, PhD; Kyra Becker, MD, FAHA; Bernard R. Bendok, MD, MS, FAHA; Mary Cushman, MD, MSc, FAHA; Gordon L. Fung, MD, MPH, PhD, FAHA; Joshua N. Goldstein, MD, PhD, FAHA; R. Loch Macdonald, MD, PhD, FRCS; Pamela H. Mitchell, RN, PhD, FAHA; Phillip A. Scott, MD, FAHA; Magdy H. Selim, MD, PhD; Daniel Woo, MD, MS; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, and Council on Clinical Cardiology

Purpose: The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage.

01 septiembre 2015

STROKE. Special Reports. Republished: Society for Neuroscience in Anesthesiology and Critical Care Expert Consensus Statement: Anesthetic Management of Endovascular Treatment for Acute Ischemic Stroke*

Pekka O. Talke, MD†; Deepak Sharma, MD, DM‡; Eric J. Heyer, MD, PhD§; Sergio D. Bergese, MD‖; Kristine A. Blackham, MD¶; Robert D. Stevens, MD#

Abstract: Literature on the anesthetic management of endovascular treatment of acute ischemic stroke (AIS) is limited. Anesthetic management during these procedures is still mostly dependent on individual or institutional preferences. Thus, the Society of Neuroscience in Anesthesiology and Critical Care (SNACC) created a task force to provide expert consensus recommendations on anesthetic management of endovascular treatment of AIS.

20 mayo 2014

STROKE. AHA/ASA Scientific Statement. Physical Activity and Exercise Recommendations for Stroke Survivors. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Sandra A. Billinger, PT, PhD, FAHA, Chair; Ross Arena, PT, PhD, FAHA, Co-Chair; Julie Bernhardt, PT, PhD; Janice J. Eng, BSc, PT/OT, PhD; Barry A. Franklin, PhD, FAHA; Cheryl Mortag Johnson, OTR; Marilyn MacKay-Lyons, BSc, MScPT, PhD; Richard F. Macko, MD; Gillian E. Mead, MD, MA, FRCP; Elliot J. Roth, MD, FAHA; Marianne Shaughnessy, PhD, RN, CRNP; Ada Tang, PT, PhD; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Lifestyle and Cardiometabolic Health, Council on Epidemiology and Prevention, and Council on Clinical Cardiology

Purpose: This scientific statement provides an overview of the evidence on physical activity and exercise recommendations for stroke survivors. Evidence suggests that stroke survivors experience physical deconditioning and lead sedentary lifestyles. Therefore, this updated scientific statement serves as an overall guide for practitioners to gain a better understanding of the benefits of physical activity and recommendations for prescribing exercise for stroke survivors across all stages of recovery.

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