Intravenous fibrinolysis eligibility: A survey of stroke clinicians' practice patterns and review of the literature

Felipe De Los Rios, Dawn O. Kleindorfer, Amy Guzik, Santiago Ortega-Gutierrez, Navdeep Sangha, Gyanendra Kumar, James C. Grotta, Jin Moo Lee, Brett C. Meyer, Lee H. Schwamm, Pooja Khatri

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Background 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.

Methods 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.

Conclusions 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.

Results 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.

Original languageEnglish
Pages (from-to)2130-2138
Number of pages9
JournalJournal of Stroke and Cerebrovascular Diseases
Volume23
Issue number8
DOIs
StatePublished - Sep 1 2014

Keywords

  • Stroke
  • infarction
  • rtPA
  • stroke treatment
  • thrombolysis
  • tissue plasminogen activator

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