Journal article
Intravenous Fibrinolysis Eligibility: A Survey of Stroke Clinicians' Practice Patterns and Review of the Literature
Journal of stroke and cerebrovascular diseases, Vol.23(8), pp.2130-2138
09/2014
DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.024
PMCID: PMC4157964
PMID: 25113084
Abstract
The indications and contraindications for intravenous (IV) recombinant tissue plasminogen activator (rtPA) use in ischemic stroke can be confusing to the practicing neurologist. Here we seek to describe practice patterns regarding decision-making among US stroke clinicians.
Stroke clinicians (attending and fellow) from the 8 National Institutes of Health SPOTRIAS (Specialized Programs of Translational Research in Acute Stroke) centers were asked to complete a survey ahead of the 2012 SPOTRIAS Investigators' meeting.
A total of 51 surveys were collected (71% response rate). Most of the responders were attending physicians (68%). Only 18% of clinicians reported strictly adhering to current American Heart Association guidelines for treatment within 3 hours from symptom onset; this increased to 51% for the European Cooperative Acute Stroke Study (ECASS) III criteria in the 3 to 4.5 hours time frame. All clinicians treat eligible patients in the 3 to 4.5 hours time frame. The great majority will recommend rtPA in the following scenarios: (1) elderly individuals irrespective of age (97%); (2) severe stroke irrespective of National Institutes of Health Stroke Scale (NIHSS) (95%); or (3) suspected stroke with seizures at symptom onset (91%). None recommended rtPA in the setting of an international normalized ratio >1.7. Most clinicians defined mild strokes as an exclusion based on the perceived disability of the deficit (80%) rather than on a specific NIHSS threshold.
Most surveyed stroke clinicians seem to find that the current IV rtPA eligibility criteria for the 3-hour time frame too restrictive. All would recommend rtPA to eligible patients in the 3 to 4.5 hours time frame despite the absence of an U.S. Food and Drug Administration (FDA)-approved indication.
Details
- Title: Subtitle
- Intravenous Fibrinolysis Eligibility: A Survey of Stroke Clinicians' Practice Patterns and Review of the Literature
- Creators
- Felipe De Los Rios - Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OhioDawn O Kleindorfer - Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OhioAmy Guzik - Department of Neuroscience, University of California San Diego, San Diego, CaliforniaSantiago Ortega-Gutierrez - Department of Neurology, Columbia University, New York, New YorkNavdeep Sangha - Department of Neurology, University of Texas, Houston, TexasGyanendra Kumar - Department of Neurology, Washington University, St. Louis, MissouriJames C Grotta - Department of Neurology, University of Texas, Houston, TexasJin-Moo Lee - Department of Neurology, Washington University, St. Louis, MissouriBrett C Meyer - Department of Neuroscience, University of California San Diego, San Diego, CaliforniaLee H Schwamm - Department of Neurology, Harvard Medical School, Boston, MassachussetsPooja Khatri - Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Resource Type
- Journal article
- Publication Details
- Journal of stroke and cerebrovascular diseases, Vol.23(8), pp.2130-2138
- DOI
- 10.1016/j.jstrokecerebrovasdis.2014.03.024
- PMID
- 25113084
- PMCID
- PMC4157964
- NLM abbreviation
- J Stroke Cerebrovasc Dis
- ISSN
- 1052-3057
- eISSN
- 1532-8511
- Publisher
- Elsevier Inc
- Grant note
- R01 NS30678; P50 NS044283-09 / NIH NINDS
- Language
- English
- Date published
- 09/2014
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020771802771
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