What are eCASS III exclusion criteria?
Exclusion Criteria
- Intracranial hemorrhage on CT or MRI.
- Symptoms of subarachnoid hemorrhage even without signs on CT.
- Major ischemic infarct on CT or MRI.
- NIHSS score >25.
- Seizure at onset of stroke.
- Unknown onset of symptoms or greater than 4.5 hours prior to drug administration.
What major conditions exclude patients from reperfusion therapy with alteplase?
The most common exclusion for alteplase is dominated by delays in presentation to medical attention. Within a population, only 22% to 31% of patients with ischemic stroke present to an emergency department within 3 hours from symptom onset. In addition, arrival times to presentation are not linearly distributed.
When should you not give tPA?
Other Contraindications for tPA Arterial puncture at a noncompressible site in previous 7 days. History of previous intracranial hemorrhage. Intracranial neoplasm, AVM, or an aneurysm. Recent intracranial or intraspinal surgery.
What is the extent of clinical experience with Activase?
Activase® is proven to reduce disability at 90 days in patients treated within 3 hours of symptom onset.
What happens if you give tPA after 4 hours?
Although beneficial within 4.5 hours of stroke onset, administering recombinant tissue plasminogen activator (tPA) beyond that window appears to increase the risk of dying, a pooled analysis of eight clinical trials showed.
Which of the following criteria must be met in order to consider a patient eligible for treatment with Activase?
With a platelet count <100,000/mm, international normalized ratio (INR) >1.7, activated partial thromboplastin time (aPTT) >40 seconds, or prothrombin time (PT) >15 seconds.
For which reason would a patient be excluded from receiving rtPA within 3 to 4.5 hours from the onset of a stroke?
Uncontrolled hypertension to values exceeding a systolic of 185 mm Hg or diastolic of 110 mm Hg is an exclusion criterion to IV rtPA according to the 2013 AHA guidelines and the drug label. This is likely derived from an exclusion criterion for the National Institute of Neurological Disorders and Stroke (NINDS) trials.
Is Heparin a contraindication for tPA?
Low-Molecular-Weight Heparin Intravenous thrombolysis for stroke is contraindicated if the patient is taking therapeutic doses of LMWH because of the presumed high risk of hemorrhagic complications.
What happens if tPA is given after 3 hours?
“From analyzing all the available data, tPA [tissue plasminogen activator] after 3 hours for stroke patients may not be of any benefit but has a definite risk of fatal bleeding,” Dr Alper told Medscape Medical News.
How quickly does tPA work?
When administered quickly after stroke onset (within three hours, as approved by the FDA), tPA helps to restore blood flow to brain regions affected by a stroke, thereby limiting the risk of damage and functional impairment.
What are the results of The ECASS III trial?
The ECASS III results can be looked at from 2 different depths of scrutiny. Superficially, the results clearly demonstrate that IV tPA improves 90-day outcome in patients meeting the inclusion/exclusion criteria of the trial.
Are there subtypes of stroke in ECASS III?
In the ECASS III paper, no information is provided about stroke subtypes nor the relationship of baseline severity on the National Institutes of Health Stroke Scale or age to response to IV tPA treatment.
Is the 3-4.5 HR exclusion criteria associated with worse outcomes?
Conclusions: Patients with ECASS III-specific exclusion criteria for the 3-4.5 hr window are frequently treated with IV tPA in the U.S. The exclusion criteria were not associated with worse outcomes in the 3-4.5 hr window compared to the <3 hr window.
Which is the most common exclusion criterion for tPA?
The most common additional exclusion among treated patients was age > 80. With the exception of prior stroke and diabetes, the percent of tPA treated patients with each exclusion criterion was lower at 3-4.5 hr compared with <3 hr (Table 1A).