STROKE-tPA INCLUSION CRITERIA
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)
- ↑ 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.
- ↑ 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.
- ↑ Wardlaw, J.M., Murray, V., Berge, E. and Del Zoppo, G.J., 2014. Thrombolysis for acute ischaemic stroke. Cochrane database of systematic reviews, (7).
- ↑ 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].
