Abstract | BACKGROUND: 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. 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. 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.
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Authors | 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, SPOTRIAS Investigators |
Journal | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
(J Stroke Cerebrovasc Dis)
Vol. 23
Issue 8
Pg. 2130-2138
(Sep 2014)
ISSN: 1532-8511 [Electronic] United States |
PMID | 25113084
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Copyright | Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Fibrinolytic Agents
- Recombinant Proteins
- Tissue Plasminogen Activator
|
Topics |
- Aged
- Aged, 80 and over
- Aging
(drug effects)
- Data Collection
- Eligibility Determination
(standards, statistics & numerical data)
- Female
- Fibrinolytic Agents
(administration & dosage, therapeutic use)
- Humans
- Male
- Middle Aged
- Physicians
- Practice Patterns, Physicians'
(standards)
- Recombinant Proteins
(administration & dosage, therapeutic use)
- Review Literature as Topic
- Stroke
(drug therapy)
- Thrombolytic Therapy
(methods, standards)
- Time Factors
- Tissue Plasminogen Activator
(administration & dosage, therapeutic use)
- Treatment Outcome
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