Title

Pennsylvania comprehensive stroke center collaborative: Statement on the recently updated IV rt-PA prescriber information for acute ischemic stroke

Authors

Badih Daou, Thomas Jefferson University Hospital, Department of Neurosurgery, Philadelphia, PA, United States.
Maureen Deprince, Thomas Jefferson University Hospital, Department of Neurosciences Institute, Philadelphia, PA, United States.
Robin D'Ambrosio, Thomas Jefferson University Hospital, Department of Neurosciences Institute, Philadelphia, PA, United States.
Stavropoula Tjoumakaris, Thomas Jefferson University Hospital, Department of Neurosurgery, Philadelphia, PA, United States.
Robert H. Rosenwasser, Thomas Jefferson University Hospital, Department of Neurosurgery, Philadelphia, PA, United States.
Daniel J. Ackerman, Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, United States.
Rodney Bell, Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, United States.
Diana L. Tzeng, Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, United States.
Michelle Ghobrial, Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, United States.
Andres Fernandez, Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, United States.
Qaisar Shah, Abington Memorial Hospital, Division of Neurointervention and Neuocritical Care, Abington, PA, United States.
Dan J. Gzesh, Diamond Stroke Center, Abington, PA, United States.
Deborah Murphy, Abington Memorial Hospital, Division of Neurointervention and Neuocritical Care, Abington, PA, United States.
John E. Castaldo, Lehigh Valley Health Network Division of Neurology, Allentown, PA, United States.
Claranne Mathiesen, Lehigh Valley Health Network Division of Neurology, Allentown, PA, United States.
Maria Carissa Pineda, Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, United States.
Pascal Jabbour, Thomas Jefferson University Hospital, Department of Neurosurgery, Philadelphia, PA, United States. Electronic address: pascal.jabbour@jefferson.edu.

Document Type

Article

Publication Title

Clinical neurology and neurosurgery

Abstract

OBJECTIVE: Recently, the FDA guidelines regarding the eligibility of patients with acute ischemic stroke to receive IV rt-PA have been modified and are not in complete accord with the latest AHA/ASA guidelines. The resultant differences may result in discrepancies in patient selection for intravenous thrombolysis. METHODS: Several comprehensive stroke centers in the state of Pennsylvania have undertaken a collaborative effort to clarify and unify our own recommendations regarding how to reconcile these different guidelines. RESULTS: Seizure at onset of stroke, small previous strokes that are subacute or chronic, multilobar infarct involving more than one third of the middle cerebral artery territory on CT scan, hypoglycemia, minor or rapidly improving symptoms should not be considered as contraindications for intravenous thrombolysis. It is recommended to follow the AHA/ASA guidelines regarding blood pressure management and bleeding diathesis. Patients receiving factor Xa inhibitors and direct thrombin inhibitors within the preceding 48 h should be excluded from receiving IV rt-PA. CT angiography is effective in identifying candidates for endovascular therapy. Consultation with and/or transfer to a comprehensive stroke center should be an option where indicated. Patients should receive IV rt-PA up to 4.5h after the onset of stroke. CONCLUSIONS: The process of identifying patients who will benefit the most from IV rt-PA is still evolving. Considering the rapidity with which patients need to be evaluated and treated, it remains imperative that systems of care adopt protocols to quickly gather the necessary data and have access to expert consultation as necessary to facilitate best practices.

First Page

264

Last Page

8

DOI

10.1016/j.clineuro.2015.10.010

Publication Date

12-1-2015

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