Dosing errors did not have a major impact on outcome in the NINDS t-PA stroke study

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
Steven R MesséNINDS t-PA Stroke Study Group

Abstract

Intravenous tissue plasminogen activator (IV t-PA) for acute stroke is dosed by weight, which is typically estimated, and requires a multistep infusion, which may lead to administration errors. We evaluated the impact of dosing errors on outcome in the National Institute of Neurological Disorders and Stroke (NINDS) t-PA Stroke Study. Using logistic regression, we investigated the relationship between actual weight-based dose (administered dose divided by actual weight, capped at 100 kg) and intracerebral hemorrhage (ICH) at 36 hours and likelihood of good recovery (modified Rankin score of 0 or 1) at 3 months. Estimated weight, actual weight, and total t-PA dose administered were available for 311 of 312 patients; 3 received only the bolus and were excluded. In multivariable logistic regression, there was no association between the risk of any ICH using actual dose as a continuous variable (P = .65), or when comparing the highest quintile of actual dose (>0.944 mg/kg) to the lower 4 quintiles (9.8% vs 10.9%; odds ratio [OR], 0.60; 95% confidence interval [CI], 0.22-1.61; P = .31), adjusting for age, baseline National Institutes of Health Stroke Scale (NIHSS) score, and changes on baseline computed tomography. Similarly, there w...Continue Reading

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Citations

Feb 5, 2013·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Demetrios J SahlasWieslaw Oczkowski
Dec 19, 2012·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Petr AulickyRobert Mikulik
Nov 1, 2012·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Shu-Ming PanXiang-Jun Chen
Jul 2, 2015·Journal of Internal Medicine·R Mikulik, N Wahlgren
May 31, 2017·Cerebrovascular Diseases Extra·Andreas Ragoschke-SchummKlaus Fassbender
Jul 30, 2014·The Cochrane Database of Systematic Reviews·Joanna M WardlawGregory J del Zoppo
Nov 12, 2015·Stroke; a Journal of Cerebral Circulation·Tom BarrowPankaj Sharma
May 17, 2019·International Journal of Stroke : Official Journal of the International Stroke Society·T Truc My NguyenNyika D Kruyt
Apr 28, 2020·Journal of Thrombosis and Thrombolysis·Prakash R PaliwalVijay K Sharma
Feb 15, 2021·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Chi-Yung ChengTeng-Yeow Tan

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