[Table], NINDS Patient Selection Criteria for Administration of t-PA - Minnesota Health Technology Assessments

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NINDS Patient Selection Criteria for Administration of t-PA

NINDS Patient Selection Criteria for Administration of t-PA
Patient criteria to be considered candidates for t-PA: Age 18 or older Clinical diagnosis of brain attack including CT scans assessed by physicians with expertise in reading this imaging study The time symptoms began can be reliably estimated and less than 180 minutes has elapsed from time brain attack symptoms started until treatment would begin. Patients experiencing symptoms upon awakening are excluded from t-PA therapy.
Patients are not candidates for administration of t-PA under any of the following conditions: Brain attack symptoms rapidly improving Mild or isolated signs of neurological deficits Seizure at the time brain attack symptoms began CT scan showing hemorrhage Show signs of bleeding in or around the brain even if CT is negative Show signs of heart attack or post heart attack inflammation of cardiac tissue Recent use of an oral anticoagulant or a prothrombin time greater than 15 seconds Use of heparin within the preceding 48 hours¹ and a prolonged partial thromboplastin time A platelet count of less than 100,000/mm Brain attack or serious head injury within the previous three months Major surgery within the previous 14 days On repeated measurement systolic blood pressure is greater than 185mm mercury, and diastolic blood pressure is greater than 110 mm mercury just before the point when administration is to begin, or aggressive treatment is required to control blood pressure within this range History of hemorrhage in the skull Laboratory tests show any of the following: low glucose (less than 50 mg/dl) or elevated glucose (greater than 400mg/dl) Active internal bleeding Gastrointestinal hemorrhage or urinary tract bleeding within the previous 21 days An arterial puncture at a non-compressible site within the previous seven days

Patient criteria to be considered candidates for t-PA:

Age 18 or older
Clinical diagnosis of brain attack including CT scans assessed by physicians
with expertise in reading this imaging study
The time symptoms began can be reliably estimated and less than 180 minutes has elapsed from time brain attack symptoms started until treatment would begin.
Patients experiencing symptoms upon awakening are excluded from t-PA therapy.

Patients are not candidates for administration of t-PA under any of the following conditions:

Brain attack symptoms rapidly improving
Mild or isolated signs of neurological deficits
Seizure at the time brain attack symptoms began
CT scan showing hemorrhage
Show signs of bleeding in or around the brain even if CT is negative
Show signs of heart attack or post heart attack inflammation of cardiac tissue
Recent use of an oral anticoagulant or a prothrombin time greater than 15 seconds
Use of heparin within the preceding 48 hours¹ and a prolonged partial thromboplastin time
A platelet count of less than 100,000/mm
Brain attack or serious head injury within the previous three months
Major surgery within the previous 14 days
On repeated measurement systolic blood pressure is greater than 185mm mercury, and diastolic blood pressure is greater than 110 mm mercury just before the point when administration is to begin, or aggressive treatment is required to control blood pressure within this range
History of hemorrhage in the skull
Laboratory tests show any of the following: low glucose (less than 50 mg/dl) or elevated glucose (greater than 400mg/dl)
Active internal bleeding
Gastrointestinal hemorrhage or urinary tract bleeding within the previous 21 days
An arterial puncture at a non-compressible site within the previous seven days

From: Treatment of Acute Ischemic Stroke (Brain Attack) Questions and Answers

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Minnesota Health Technology Assessments [Internet].

Minnesota Health Technology Advisory Committee.

St. Paul (MN): Minnesota Department of Health; 1995-2001.

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