tPA WINDOW EXPANDED
EXPANSION OF THE TIME WINDOW FOR TREATMENT OF ACUTE ISCHEMIC STROKE WITH INTRAVENOUS TISSUE PLASMINOGEN ACTIVATOR
An Advisory Statement from the Stroke Council, American Heart Association and American Stroke Association
Stroke published online May 28, 2009; DOI: 10.1161/STROKEAHA.109.192535
Current Management
• rt-PA is recommended for treatment of ischemic stroke in selected patients
• However, rt-PA is only administered to less than 3% of ischemic stroke patients
• Delay in presentation contributes significantly to underutilization of rt-PA for stroke
• Extending time window for rt-PA administration beyond the current recommended 3 hrs might be beneficial.
• The European Cooperative Acute Stroke Study (ECASS 3), investigated rt-PA (alteplase) treatment in the 3.0 - 4.5 hour window
Recommendations
• rt-PA should be administered to eligible pts within 3.0-4.5 hours after stroke (Class I Recommendation, LOE B)
• Eligibility criteria in this time period are similar to those for persons treated at earlier time periods with the following additional exclusion criteria:
– Age > 80 years;
– Oral anticoagulant use with INR ≤ 1.7*;
– baseline NIH Stroke Scale score > 25;
– a history of stroke and diabetes (*For the 3.0 – 4.5 hr window all pts receiving oral anticoagulant are excluded whatever their INR).
• The efficacy of IV rt-PA within 3.0 – 4.5 hours after stroke in pts with these exclusion criteria is not well-established & requires further study. (Class IIb Recommendation, LOE C)
Summary
• rt-PA may be safely administered to ischemic stroke pts meeting strict inclusion & exclusion criteria in the 3.0-4.5 hr time window
• Ancillary care for pts receiving rt-PA at 3.0-4.5 hrs after ischemic stroke should be similar to that included in the 2007 AHA Stroke Guidelines
An Advisory Statement from the Stroke Council, American Heart Association and American Stroke Association
Stroke published online May 28, 2009; DOI: 10.1161/STROKEAHA.109.192535
Current Management
• rt-PA is recommended for treatment of ischemic stroke in selected patients
• However, rt-PA is only administered to less than 3% of ischemic stroke patients
• Delay in presentation contributes significantly to underutilization of rt-PA for stroke
• Extending time window for rt-PA administration beyond the current recommended 3 hrs might be beneficial.
• The European Cooperative Acute Stroke Study (ECASS 3), investigated rt-PA (alteplase) treatment in the 3.0 - 4.5 hour window
Recommendations
• rt-PA should be administered to eligible pts within 3.0-4.5 hours after stroke (Class I Recommendation, LOE B)
• Eligibility criteria in this time period are similar to those for persons treated at earlier time periods with the following additional exclusion criteria:
– Age > 80 years;
– Oral anticoagulant use with INR ≤ 1.7*;
– baseline NIH Stroke Scale score > 25;
– a history of stroke and diabetes (*For the 3.0 – 4.5 hr window all pts receiving oral anticoagulant are excluded whatever their INR).
• The efficacy of IV rt-PA within 3.0 – 4.5 hours after stroke in pts with these exclusion criteria is not well-established & requires further study. (Class IIb Recommendation, LOE C)
Summary
• rt-PA may be safely administered to ischemic stroke pts meeting strict inclusion & exclusion criteria in the 3.0-4.5 hr time window
• Ancillary care for pts receiving rt-PA at 3.0-4.5 hrs after ischemic stroke should be similar to that included in the 2007 AHA Stroke Guidelines
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