Inclusion criteria |
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Exclusion criteria |
Patient history
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Clinical
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Hematologic
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Head CT
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Warnings¶ |
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Additional warnings for treatment from 3 to 4.5 hours from symptom onsetΔΔ
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ACS: acute coronary syndrome; aPTT: activated partial thromboplastin time; ECT: ecarin clotting time; INR: international normalized ratio; PT: prothrombin time; NIHSS: National Institutes of Health Stroke Scale; tPA: tissue plasminogen activator (alteplase or tenecteplase); TT: thrombin time; VTE: venous thromboembolism.
* Although it is desirable to know the results of these tests, thrombolytic therapy should not be delayed while results are pending unless (1) there is clinical suspicion of a bleeding abnormality or thrombocytopenia, (2) the patient is currently on or has recently received anticoagulants (eg, heparin, warfarin, a direct thrombin inhibitor, or a direct factor Xa inhibitor), or (3) use of anticoagulants is not known. Otherwise, treatment with intravenous tPA can be started before availability of coagulation test results but should be discontinued if the INR, PT, or aPTT exceed the limits stated in the table, or if platelet count is <100,000 mm3.
¶ With careful consideration and weighting of risk-to-benefit, patients may receive intravenous thrombolysis despite one or more warnings.
Δ Patients who have a persistent neurologic deficit that is potentially disabling, despite improvement of any degree, should be treated with intravenous thrombolysis in the absence of other contraindications. Any of the following should be considered disabling deficits:◊ Patients may be treated with intravenous thrombolysis if glucose level is subsequently normalized.
§ The potential risks of bleeding with tPA from injuries related to the trauma should be weighed against the anticipated benefits of reduced stroke-related neurologic deficits.
¥ The increased risk of surgical site bleeding with tPA should be weighed against the anticipated benefits of reduced stroke-related neurologic deficits.
‡ There is a low increased risk of new bleeding with tPA in the setting of past gastrointestinal or genitourinary bleeding. However, tPA administration within 21 days of gastrointestinal bleeding is not recommended.
† Intravenous thrombolysis is reasonable in patients with a seizure at stroke onset if evidence suggests that residual impairments are secondary to acute ischemic stroke and not to a postictal phenomenon.
** tPA can be given in pregnancy when the anticipated benefits of treating moderate or severe stroke outweigh the anticipated increased risks of uterine bleeding.
¶¶ The safety and efficacy of administering tPA is uncertain for these relative exclusions.
ΔΔ Although these were exclusions in the trial showing benefit in the 3 to 4.5 hour window, intravenous tPA appears to be safe and may be beneficial for patients with these criteria, including patients taking oral anticoagulants with an INR <1.7.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟