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Balancing Rapid Treatment Goals with Thorough Laboratory Evaluation in Alteplase Candidates: A Review of a Stroke Center's Current Practices and Outcomes (P4.221)
CONCLUSIONS: While it is standard practice in many centers to await coagulation results, the uncertain benefits of this delay should be weighed against the known benefit of prompt thrombolysis. Our review suggests that administering TPA prior to obtaining results in low-risk patients shortened time to treatment without increased risk of hemorrhagic complications. We propose establishing point-of-care PT/INR testing for TPA candidates in the emergency department to eliminate both unnecessary delay and risk.Disclosure: Dr. Smith has nothing to disclose. Dr. Volpi has nothing to disclose.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Smith, S., Volpi, J. Tags: Cerebrovascular Disease and Interventional Neurology: Acute Stroke Thrombolysis Source Type: research

Neurology residency program as factor associated with thrombolysis utilization in acute stroke
Despite strong evidence on the safety and efficacy of IV alteplase up to 4.5 hours after ischemic stroke (IS) symptom onset1 and increased use of thrombolysis over recent decades, this treatment remains underused and accessible to only a fraction of patients. The rate of thrombolysis in the United States is 3.4%–5.2% of all stroke cases.2 Several studies have identified barriers to thrombolysis delivery,3 but other as yet unmeasured factors may also underlie these barriers, thereby influencing rates of thrombolysis utilization and access.
Source: Neurology - December 2, 2013 Category: Neurology Authors: Lorenzano, S. Tags: Infarction EDITORIALS Source Type: research

The Elusive Golden Hour - A Multicenter Analysis of the Difficulties of Timely Intravenous Alteplase Treatment (P03.189)
CONCLUSIONS: Many factors contribute to delay in IV thrombolytic treatment in the acute stroke patient. In many patients when stabilization is needed or when the clinical presentation is confusing, it may be in the patient's best interest to delay thrombolytics until the situation is clarified. We must strive to identify causes of delay in our institutions to maintain maximum benefit of thrombolytic therapy for our patients.Disclosure: Dr. Sugg has received personal compensation for activities with Genetech as a speaker. Dr. Chaudhrey has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Ehtisham has nothing to di...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Sugg, R., Chaudhrey, B., Chen, S., Ehtisham, A., Summers, D., Rymer, M. Tags: P03 Cerebrovascular Disease III Source Type: research

Determinants of Early Outcomes in Patients with Acute Ischemic Stroke and Proximal Artery Occlusion (S02.005)
CONCLUSIONS: In acute ischemic stroke patients thought LTB from IAT, IV tPA independently predicted favorable early post-stroke outcomes. These data reinforce the recommendation to provide early, rapid IV tPA to all eligible patients. Further studies are warranted to explore the lack of IAT effect seen in this study, which may be due to small sample size, residual confounding, or interaction between the IV tPA and IAT.Disclosure: Dr. Labuzetta has nothing to disclose. Dr. Yoo has received research support from Penumbra Inc. Dr. Ali has nothing to disclose. Dr. Fitzpatrick has nothing to disclose. Dr. Hirsch has nothing to ...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Labuzetta, J., Yoo, A., Ali, S., Fitzpatrick, K., Hirsch, J., Schwamm, L., Rost, N. Tags: S02 Acute Stroke Therapy Source Type: research

"Fou Rire Prodromique" as the Presentation of a Left Frontal Ischemic Stroke (P02.040)
CONCLUSIONS: Frontal lobe involvement affecting the Broca's area, as we described in our case, has only been described once. We conclude that the patient's laughter attack was the initial manifestation of the stroke suggesting that an acute infarct of Broca's area is capable of producing this unusual clinical presentation.Disclosure: Dr. Rosales has nothing to disclose. Dr. Garcia-Gracia has nothing to disclose. Dr. Salgado has received personal compensation in an editorial capacity from Belvoir Media Group as Consulting Editor of A Special Report published by the editors of Heart Advisor Cleveland Clinic STROKE: Advances ...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Rosales, D., Garcia-Gracia, C., Salgado, E. Tags: P02 Cerebrovascular Disease II Source Type: research

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