Unsuspected Coagulopathy Rarely Prevents Iv Thrombolysis in Acute Ischemic Stroke

Lippi, Giuseppe; Favaloro, Emmanuel J.

doi:10.1212/wnl.0b013e3181d8a414

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…Rost et al 11 determined that benefits from prompt administration of intravenous tissue plasminogen activator outweighed the risk of potential complications. Lippi et al 12 point out that availability of POC devices eliminates the unnecessary risk of treating prior to receiving lab results as turnaround time for those devices is <10 minutes falling within the safe treatment window for stroke patients. According to Rizos et al, 13 in acute stroke, POC INR testing accelerates initiation of thrombolytic treatment (faster by 28 ± 12 minutes), with results agreeing closely with laboratory results (r = 0.98; P <0.01).…”

Section: Technology Use In Scenariosmentioning

confidence: 99%

Point-of-Care Hematology and Coagulation Testing in Primary, Rural Emergency, and Disaster Care Scenarios

Curtis¹,

Kost²,

Louie³

et al. 2012

Point of Care: The Journal of Near-Patient Testing &Amp; Technology

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The purpose of this article is to review current principles and criteria for obtaining Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88) waiver, identify existing point-of-care (POC) coagulation and hematology technologies, and analyze regulatory challenges regarding CLIA-waiver for those and future devices. CLIA ’88 documentation requires tests performed by laboratories with a Certificate of Waiver to be so simple that the likelihood of erroneous results by the user is negligible, or poses no unreasonable risk of harm to the patient if performed incorrectly as determined by the Secretary of Health and Human Services. “Simple” means that the test uses unprocessed samples, has a direct read-out of test results, does not have specifications for user training, and includes instructions for confirmatory testing when advisable. Currently the CLIA-waived hematology and coagulation POC devices only test for hemoglobin (Hb), hematocrit (Hct), and prothrombin time/international normalized ratio (PT/INR). The problem with these devices is the lack of multiplexing. POC coagulation and hematology devices face challenges for obtaining a waiver. These challenges include the lack of clinical needs assessment, miniturized assays that correct for interfering substances, and assays simple enough to be combined in a multiplex platform. Several scenarios demonstrate how POC coagulation or hematology devices can improve crisis care. Industry should perform needs assessment on clinicians and emergency responders to determine which analytes to incorporate on multiplex POC coagulation and hematology devices, and produce devices that address confounding factors.

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Section: Technology Use In Scenariosmentioning

confidence: 99%

Point-of-Care Hematology and Coagulation Testing in Primary, Rural Emergency, and Disaster Care Scenarios

Curtis¹,

Kost²,

Louie³

et al. 2012

Point of Care: The Journal of Near-Patient Testing &Amp; Technology

View full text Add to dashboard Cite

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Administration of tissue plasminogen activator without coagulation results in a Chinese population

et al. 2018

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Routine coagulation test before intravenous tissue plasminogen activator (tPA) use increases the door to needle time (DNT). We sought to evaluate the safety of tPA use without coagulation results and its impact on prognosis. In our stroke registry, tPA was delivered with coagulation results from December 2015 to April 2016 and without coagulation results from May 2016 to December 2016. Differences of demographics, clinical characteristic, and prognosis between these two groups were analyzed. In addition, logistic regression analysis was conducted to identify predictors for DNT of over 60 min. A total of 201 stroke patients were included in the final analysis. Of these, 81 patients received tPA with coagulation results and 120 patients without coagulation results. Only one (0.8%) patient with abnormal coagulation results met the exclusion criteria of tPA use in patients without coagulation results. The difference of DNT between groups with (mean, 61.7 min) and without (mean, 41.9 min) coagulation results was significant (P = 0.00). The group without coagulation results had a higher rate of favorable 90-day outcome (74.2 vs 70.4%) and lower rates of symptomatic intracranial hemorrhage/nonintracranial hemorrhage (4.9 and 22.2% vs 1.7 and 19.2%) than the group with coagulation results did; these differences were not statistically significant. In multivariate analysis, only tPA use with coagulation results was the predictor for DNT of over 60 min (P = 0.0030, OR = 2.44, 95% CI 1.28-4.65). The present study suggests that tPA could be delivered safely without coagulation results in patients without suspected coagulopathy, and avoiding coagulation tests reduces significantly the DNT interval.

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Unsuspected Coagulopathy Rarely Prevents Iv Thrombolysis in Acute Ischemic Stroke

Abstract: Background:

Cited by 2 publications

References 19 publications

Point-of-Care Hematology and Coagulation Testing in Primary, Rural Emergency, and Disaster Care Scenarios

Point-of-Care Hematology and Coagulation Testing in Primary, Rural Emergency, and Disaster Care Scenarios

Administration of tissue plasminogen activator without coagulation results in a Chinese population

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