Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke a guideline for healthcare professionals from the American Heart Association/American Stroke Association

Background and Purpose-The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendationsin a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiencesare prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelinessupersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines.Methods-Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council'sScientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowedto participate in discussions or to vote on topics relevant to their relations with industry. An update of the 2013 AISGuidelines was originally published in January 2018. This guideline was approved by the AHA Science Advisory andCoordinating Committee and the AHA Executive Committee. In April 2018, a revision to these guidelines, deleting somerecommendations, was published online by the AHA. The writing group was asked review the original document andrevise if appropriate. In June 2018, the writing group submitted a document with minor changes and with inclusion ofimportant newly published randomized controlled trials with >100 participants and clinical outcomes at least 90 days afterAIS. The document was sent to 14 peer reviewers. The writing group evaluated the peer reviewers' comments and revised when appropriate. The current final document was approved by all members of the writing group except when relationshipswith industry precluded members from voting and by the governing bodies of the AHA. These guidelines use the AmericanCollege of Cardiology/AHA 2015 Class of Recommendations and Level of Evidence and the new AHA guidelines format.Results-These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterialtherapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings.Conclusions-These guidelines provide general recommendations based on the currently available evidence to guideclinicians caring for adult patients with acute arterial ischemic stroke. In many instances, however, only limited data existdemonstrating the urgent need for continued research on treatment of acute ischemic stroke.