1. What is the effect of giving tPA within 3hrs of stroke onset?
2. What is the inclusion and exclusion criteria for tPA?
3. What are possible indications for anticoagulation?
4. How long following the CVA should anticoagulation for cardiac emboli be started?
Answers:
1. 30% reduction in disability, increased mortality.
2. Inclusion: age >18yrs, onset within 3hrs, moderate to severe symptoms, and head CT negative for blood. Exclusion: minor symptoms, CT positive for blood, BP >185/100, increased PT/PTT, decreased plt, hypoglycemia, hyperglycemia (>400), h/o CVA within 3 months, h/o ICH/AVM/aneurysm, seizures.
3. Cardiac emboli (most commonly from chronic a-fib), TIAs (especially of increasing frequency). Possibly used for a mild stroke, to prevent further progression.
4. If deficit is mild, start immediate anticoagulation. If deficit severe, wait 3-5 days.
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2 comments:
Answer #1 should read, "DECREASED mortality". There is a higher incidence of bleeding with TPA but mortality overall is less than compared with placebo.
Several studies have shown an increase in mortality in the TPA group. The NINDS trial which Cuccurullo cites did not show any *significant* difference between mortality in the placebo and TPA groups.
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