Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic stroke.

Neurology
N S RostLee H Schwamm

Abstract

American Heart Association/American Stroke Association guidelines recommend initiating treatment with IV tissue plasminogen activator (tPA) in acute ischemic stroke patients without suspected coagulopathy prior to availability of clotting results; however, little or no data support this practice. We sought to identify how often blood clotting abnormalities were responsible for withholding IV tPA at our institution. We conducted a retrospective review of our prospectively acquired Get With the Guidelines Stroke database from January 2003 to April 2008. All patients underwent clinical evaluation by a neurologist, diagnostic neuroimaging, and laboratory testing on admission. We classified patients with absolute contraindications to IV tPA as ineligible, and those with warnings/relative contraindications or potentially treatable factors as potentially eligible. Of 2,335 considered for analysis, 470 (20.1%) patients presented to our emergency department (ED) within 3 hours. Among these, 147 (31.3%) received IV tPA in our ED, 102 (21.7%) had an absolute contraindication, and 221 (47%) had a reason to consider withholding tPA. Only 30/470 (6.4%) of potential thrombolysis patients were discovered to have international normalized ratio ...Continue Reading

Citations

May 11, 2010·Current Atherosclerosis Reports·Neelofer Shafi, Joshua M Levine
Sep 27, 2013·PloS One·Julia FerrariUNKNOWN Austrian Stroke Unit Registry Collaborators
Apr 5, 2014·Continuum : Lifelong Learning in Neurology·Pooja Khatri
Sep 15, 2012·Emergency Medicine Clinics of North America·Jillian M Perry, Kerry K McCabe
Mar 4, 2014·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Yukai LiuNa Luo
Feb 24, 2015·La Presse médicale·Marion Masingue, Sonia Alamowitch
Nov 14, 2014·CNS Drugs·Stephen A FigueroaVenkatesh Aiyagari
Oct 16, 2016·Emergency Medicine Clinics of North America·Lauren M Nentwich
Sep 15, 2016·Circulation. Cardiovascular Quality and Outcomes·Shyam PrabhakaranKathleen O'Neill
Jun 12, 2010·Stroke; a Journal of Cerebral Circulation·Atte MeretojaMarkku Kaste
Jan 26, 2018·Neurology·Henrik GensickeUNKNOWN Thrombolysis in Stroke Patients (TRISP) Collaborators
May 5, 2010·Neurology·Giuseppe Lippi, Emmanuel J Favaloro

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