Abstract WP56: 2021 Comparison Of International Stroke Guidelines For Acute Ischemic Stroke

Abstract

Background: Many countries/regions have formal Acute Ischemic Stroke (AIS) management guidelines. Variations between guidelines may showcase differences in demographic epidemiology and practice that correspond to the regional or national priorities. Methods: We systemically searched for guideline recommendations on AIS management published between January 1, 2004, and August 20, 2021. With only the latest guideline for each country selected, 11 guidelines from countries/regions of the world were identified and reviewed: United States (2018), Japan (2013), Europe (2018), Australia (2012), Brazil (2012), China (2019), Korea (2019), Canada (2018), India (2011), South Africa (2010), and Malaysia (2006). Results: Urgent imaging guidelines, such as CT or MRI, for initial evaluation are similar across countries; nevertheless, initial intravascular imaging guidelines greatly differ. Of the eleven countries reviewed, the majority recommend a standard tPA dose of 0.9mg/kg, while Japan and China recommend a lower tPA dose of 0.6mg/kg in select patients. While time to initiation of aspirin (ASA) post IV thrombolysis is widely accepted, consensus on the appropriate ASA dose, and possible addition of other antiplatelet therapies does not exist. Mechanical thrombectomy is overall endorsed within 6 hours or between 6-16 hours of symptom onset with causative occlusion, but countries such China and Canada have found validity extending the timeframe to 24hrs and beyond, using imaging modality recommendations. Inpatient management of nutrition, DVT prophylaxis, and rehabilitation differ between the various guidelines. Conclusion: Variations between guidelines exist that highlights those components with a lack of an evidence-based consensus. With further international collaboration, reconciliation of guidelines between countries or regions may be achievable.