Background:
Most of the original exclusion criteria for recombinant tissue plasminogen activator (rt-PA) from NINDS trial, European, and FDA contribute to the low rt-PA use because of their stringent criteria. The new AHA/ASA guideline suggests that by relaxing the already existing criteria the use of rt-PA could be increased from its current use. The impact of the new AHA/ASA guideline in expanding the use, outcomes and benefits of rt-PA is not clear. We determined these issues in the current study.
Methods:
We characterized absolute and relative contraindications to rt-PA using a large sample size collected between 2010 and 2013 in a stroke registry. We analyzed both imaging and rt-PA data to determine whether there would have been significant increase in use, outcomes and benefit of rt-PA if the AHA/ASA guideline was used instead of the old FDA package insert of Alterplase (Activase).
Results:
A total of 663 ischemic stroke patients were eligible to receive rt-PA. Out of the 663, 241 received rt-PA and 422 did not. We identified specific differences in outcomes and contributing factors to contraindications at the level of individual patients and stroke population. We observed clinical conditions of similar exclusion criteria but with differential stroke deficits in both AHA/ASA guideline and the old FDA package insert of Alterplase (Activase).
Conclusion:
Although the new AHA guideline may serve the purpose of helping to expand the safe and judicious use of alteplase after stroke, there are specific clinical factors that are necessary to achieve the goal of the new AHA/ASA guideline.
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