Anticoagulation in Acute Ischemic Stroke. TPA: Tissue Plasminogen Activator. 1995: NINDS study of TPA administration Design: randomized, double blind placebo-controlled study. N=624 Dosing: 0.9mg/kg (10% bolus, 90% given over 60 minutes)
1995: NINDS study of TPA administration
Design: randomized, double blind placebo-controlled study.
Dosing: 0.9mg/kg (10% bolus, 90% given over 60 minutes)
Outcomes: At 12 months tpa patients were 30% more likely to have minimal or no disability.
1996: FDA approved TPA for acute stroke management.
Additional Studies: ECASS I/II and Atlantis: Concluded the earlier the better (< 3hrs) and there is improved outcome if no significant infarct on CT.
**Clinical diagnosis of stroke with measurable deficit.
** Time: < 3 hours (based on the last time patient was seen normal)
** Previously independent functional status.
1. CVA or head trauma 3 months prior
2. Cerebral Aneurysm or known AVM.
3. MI in the 3 months prior
4. Any history of intracranial hemorrhage
1. spontaneously clearing stroke symptoms
2. BP >185 or diastolic >110.
1. Platelets <100,000
2. INR >1.7 on oral anticoagulants
**Radiology:Evidence of multi-lobar infarction with >33% cerebral involvement or hemorrhage or mass on CT
1. Major surgery <14 days prior
2. GI or GU bleeding <21 days prior
3. LP <7 days prior.
4. Arterial puncture at non-compressible site <7 day prior.
**Labs: Glucose <50 or >400
1. no treatment
2. ASA 300mg
3. heparin 5000 units SQ BID
4. Heparin 5000 U SQ BID + ASA 300mg
5. Heparin 12,500 U SQ BID + ASA 300mg
6. Heparin 12, 500U SQ
>ASA led to significantly fewer recurrent ischemic stroke.
>ASA led to decreased death and dependence at 6 months.
>ASA was NOT associated with an excess of hemorrhagic strokes.