Difference between revisions of "STROKE-tPA INCLUSION CRITERIA"

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<br/>2. Onset of symptoms <b style="color: rgb(32, 33, 36); font-family: arial, sans-serif; font-size: 16px;">≤</b> 4.5 hours (last known to be well or midpoint of sleep)
<br/>2. Onset of symptoms <b style="color: rgb(32, 33, 36); font-family: arial, sans-serif; font-size: 16px;">≤</b> 4.5 hours (last known to be well or midpoint of sleep)
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<br/>3. 9 hours if there is perfusion mismatch (Ma et al 2019, Campbell et al 2019)
<br/>3. 9 hours if there is perfusion mismatch<ref>Ma, H., Campbell, B.C., Parsons, M.W., Churilov, L., Levi, C.R., Hsu, C., Kleinig, T.J., Wijeratne, T., Curtze, S., Dewey, H.M. and Miteff, F., 2019. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. <i>New England Journal of Medicine,</i> 380(19), pp.1795-1803.</ref><ref>Campbell, B.C., Ma, H., Ringleb, P.A., Parsons, M.W., Churilov, L., Bendszus, M., Levi, C.R., Hsu, C., Kleinig, T.J., Fatar, M. and Leys, D., 2019. Extending thrombolysis to 4· 5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. <i>The Lancet,</i> 394(10193), pp.139-147.</ref>
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<br/>4. Age &gt; 18 years
<br/>4. Age &gt; 18 years
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<br/><i>EVIDENCE</i>
<br/><i>EVIDENCE</i>
<br/><i>In the National Institute of Neurologic Disorders (NINDS) trial (1995), patients given tPA within 3 hours of onset of stroke were 30% more likely to have minimal or no disability at 3 months compared to patients treated with placebo. Wardlaw et al. 2014, Emberson et al. 2014 demonstrated benefit of tPA within 4.5 hours.</i>
<br/><i>In the National Institute of Neurologic Disorders (NINDS) trial (1995), patients given tPA within 3 hours of onset of stroke were 30% more likely to have minimal or no disability at 3 months compared to patients treated with placebo. Wardlaw et al. 2014, Emberson et al. 2014 demonstrated benefit of tPA within 4.5 hours</i><ref>Wardlaw, J.M., Murray, V., Berge, E. and Del Zoppo, G.J., 2014. Thrombolysis for acute ischaemic stroke. <i>Cochrane database of systematic reviews,</i> (7).</ref><ref>Emberson, J., Lees, K.R., Lyden, P., Blackwell, L., Albers, G., Bluhmki, E., Brott, T., Cohen, G., Davis, S., Donnan, G. and Grotta, J., 2014. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. <i>The Lancet, </i>384(9958), pp.1929-1935.</ref><i>.</i>




==Reference(s)==
==Reference(s)==
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. [https://amzn.to/3YHrI6K Get it on Amazon.]
<references />
<br/>Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. [https://amzn.to/3YHrI6K Get it on Amazon.]
<br/>Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. [https://amzn.to/3k7WSW0 Get it on Amazon.]
<br/>Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. [https://amzn.to/3k7WSW0 Get it on Amazon.]
<br/>Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
<br/>Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.

Latest revision as of 11:07, 20 March 2023

SUMMARY

CRITERIA

1. Diagnosis of ischemic stroke causing measurable neurologic deficit

2. Onset of symptoms 4.5 hours (last known to be well or midpoint of sleep)

3. 9 hours if there is perfusion mismatch[1][2]
4. Age > 18 years

5. CTB negative for ICH

6. Informed consent of the patient

EVIDENCE
In the National Institute of Neurologic Disorders (NINDS) trial (1995), patients given tPA within 3 hours of onset of stroke were 30% more likely to have minimal or no disability at 3 months compared to patients treated with placebo. Wardlaw et al. 2014, Emberson et al. 2014 demonstrated benefit of tPA within 4.5 hours[3][4].


Reference(s)

  1. Ma, H., Campbell, B.C., Parsons, M.W., Churilov, L., Levi, C.R., Hsu, C., Kleinig, T.J., Wijeratne, T., Curtze, S., Dewey, H.M. and Miteff, F., 2019. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. New England Journal of Medicine, 380(19), pp.1795-1803.
  2. Campbell, B.C., Ma, H., Ringleb, P.A., Parsons, M.W., Churilov, L., Bendszus, M., Levi, C.R., Hsu, C., Kleinig, T.J., Fatar, M. and Leys, D., 2019. Extending thrombolysis to 4· 5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. The Lancet, 394(10193), pp.139-147.
  3. Wardlaw, J.M., Murray, V., Berge, E. and Del Zoppo, G.J., 2014. Thrombolysis for acute ischaemic stroke. Cochrane database of systematic reviews, (7).
  4. Emberson, J., Lees, K.R., Lyden, P., Blackwell, L., Albers, G., Bluhmki, E., Brott, T., Cohen, G., Davis, S., Donnan, G. and Grotta, J., 2014. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. The Lancet, 384(9958), pp.1929-1935.


Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].