Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke

Fugate, Jennifer E.; Rabinstein, Alejandro A.

doi:10.1177/1941874415578532

Cited by 145 publications

(130 citation statements)

References 109 publications

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“…This finding was supported by both a meta-analysis of 234 patients and a prospective study involving 39 patients (77). Regarding this, we can say that IV tPA can be used in acute stroke due to extracranial arterial dissection (69). Dilatation of the dissection, rupture or enlargement of the aneurysm has not been reported following IV tPA (78).…”

Section: Question: Can IV Tpa Be Administered If There Is An Intracrasupporting

confidence: 63%

“…The diagnosis of SAH in imaging was found to be 5% in patients with aneurysms and 6% in patients without aneurysms (68). In these series, the frequency of aneurysm was between 3-9.5% and rupture of the aneurysm after IV tPA was not reported (69), but 15% of aneurysms were greater than 5 mm and only 6.3% were over 10 mm in diameter (70). The AHA commission noted that the presence of aneurysms with a diameter less than 10 mm on CT angiography would not change the IV tPA decision and that larger aneurysms could not be assured of safety and more experience was needed (7).…”

Section: Question: What Is the Importance Of Early Infarction Signs Imentioning

confidence: 75%

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Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Topçuoğlu¹,

Arsava²,

Özdemi̇r³

et al. 2017

tnd

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162Use of intravenous tissue plasminogen activator (tPA) is one of the key elements of acute ischemic stroke management. Its use has not become widespread, and has faced significant problems in our country for more than a quarter of a century most probably due to many unanswered questions about issues related with daily practice. However, recent developments, which adequately focused and found solutions for most of these problems and questions, have led to a major change of point of view and understanding of the hyperacute management of stroke. This article, in the light of the relevant literature, discusses and provides clear recommendations for questions directed by neurologists practicing in Turkey mainly about typical neurologic issues faced in the setting of tPA use for acute stroke.Keywords: Stroke, thrombectomy, contraindication, avoidance, training Akut iskemik inme tedavisinin kritik elementlerinin başında gelen intravenöz doku plazminojen aktivatörü (tPA) kullanımının yirmi yılı aşkın süre içinde ülkemizde yeterince yaygınlaşamamasının başta gelen nedenlerinden biri, kullanımına dair birçok sorunun yanıtsız kalmasıdır. Ancak, son gelişmeler ile bu soruların pek çoğuna yeterli açıklamanın getirilebilmiş olması önemli bir anlayış değişikliğine yol açmaktadır. Bu makalede akut inmede tPA tedavisi ile ilgili uzmanlarımızın yönelttiği birincil olarak nörolojik sorulara ilişkin yanıt ve açıklamalar mevcut literatür ışığında etraflıca ele alınmış ve herbiri için net tavsiyelerde bulunulmuştur.Anahtar Kelimeler: Strok, trombektomi, kontrendikasyon, kaçınma, eğitim Abstract Öz

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Section: Question: Can IV Tpa Be Administered If There Is An Intracrasupporting

confidence: 63%

Section: Question: What Is the Importance Of Early Infarction Signs Imentioning

confidence: 75%

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Topçuoğlu¹,

Arsava²,

Özdemi̇r³

et al. 2017

tnd

View full text Add to dashboard Cite

show abstract

“…The European guidelines, ECASS I, ECASS III, and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) permit systemic thrombolysis in this patient subset. 201 Notably, searches yielded no Level A or B evidence to support alteplase contraindication.…”

Section: Active Internal Bleeding or History Of Gastrointestinal And mentioning

confidence: 99%

“…The elimination half-life of factor Xa inhibitors is increased in patients with renal failure. 201 in their recent review of intravenous alteplase contraindications, the terms recent and major introduce discretion and uncertainty into intravenous alteplase administration for this patient subset. Moreover, time frames for surgical patient exclusion range from 14 days in the 2 NINDS trials to 3 months in the ECASS trials.…”

Section: Oral Factor Xa Inhibitors (Apixaban and Rivaroxaban)mentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

Self Cite

585

237

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Purpose-To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 24, 2015, and the American Heart Association Executive Committee on October 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The online-only Data Supplement, which contains literature search strategies and Figures A, B, and C, is available with this article at http://circ. ahajournals.org/lookup/suppl/doi:10.1161/STR.0000000000000086/-/DC1.The American Heart Association requests that this document be cited as follows: Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rational...

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“…While due diligence must be exercised, strict interpretations of relative contraindications might prove a barrier to potentially life changing thrombolysis in stroke [2,3] . Hence decisions regarding thrombolysis are made on a case-by-case basis [4] . We report a patient who, whilst on prasugrel and aspirin for post-myocardial infarction (MI), made a dramatic recovery from acute ischemic stroke after thrombolysis.…”

Section: Introductionmentioning

confidence: 99%

Dramatic recovery from stroke following intravenous thrombolysis in a patient on prasugrel for recent percutaneous coronary angioplasty

Meenakshisundaram¹,

Palanikumar²,

Vinoth³

et al. 2017

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How to cite this article: Meenakshi-Sundaram S, Subburamakrishnan P, Vinoth J, Madhan-Rajah SVRS, Karthik SN, Suresh P. Dramatic recovery from stroke following intravenous thrombolysis in a patient on prasugrel for recent percutaneous coronary angioplasty. Neuroimmunol Neuroinflammation 2017;4:216-8.The authors report the first case of thrombolysis in a patient already receiving both aspirin and prasugrel following a recent ischemic coronary event. A 55-year-old gentleman was treated for inferior wall myocardial infarction with aspirin, prasugrel and percutaneous angioplasty of right coronary artery. Three days following the procedure he developed acute ischemic stroke due to a left middle cerebral artery infarction with a National Institute of Health Stroke Scale (NIHSS) of 24 and was treated with alteplase. Therapy was interrupted after completion of 29 mg (for a body weight of 65 kg) dose due to oral bleeding. Fifteen minutes post thrombolysis NIHSS was 5 and dropped to zero after 12 h. This report highlights the benefits of alteplase in the context of several relative contraindications like the setting of acute myocardial infarction treated with percutaneous intervention and high NIHSS. Key words:Intravenous thrombolysis, ischemic stroke, percutaneous coronary angioplasty, prasugrel ABSTRACT Article history:

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Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke

Cited by 145 publications

References 109 publications

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Dramatic recovery from stroke following intravenous thrombolysis in a patient on prasugrel for recent percutaneous coronary angioplasty

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