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(Stroke. 2006;37:2863.)
© 2006 American Heart Association, Inc.

Editorials

Time Is Brain

Anthony J. Furlan, MD

From the The Cleveland Clinic, Department of Neurology, Cleveland, Ohio.

Correspondence to Anthony J. Furlan, The Cleveland Clinic, Department of Neurology/S91, 9500 Euclid Ave, Cleveland, OH 44195. E-mail furlana@ccf.org

Key Words: acute care • tPA

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Since its initial approval in 1996, intravenous tissue plasminogen activator (IV tPA) within 3 hours of onset remains the only FDA-approved treatment for acute ischemic stroke. Although a metanalysis suggests statistical benefit from IV tPA up to 4.5 hours after ischemic stroke onset, the major benefit occurs within 90 minutes of stroke onset.¹ It is regrettable, therefore, that it often seems IV tPA is administered at 2 hours and 59 minutes if it is administered at all.

In this issue of Stroke,² the 6 affiliated hospitals of the University of California, San Diego (UCSD), stroke system describe their "expedited code stroke protocol" under which almost 50% of patients who receive IV tPA are treated within 2 hours of stroke onset compared with the more typical 20% or less.

The UCSD team suggests that IV tPA delays are often related to "clinical habits" rather than the need to meet required exclusion and inclusion criteria. Three key "habits" were eliminated: First, routine blood tests except for glucose. Interestingly, blood glucose is not a required test before giving IV tPA but hypoglycemia can mimic acute stroke and is readily reversible. The risk of eliminating a routine international normalized ratio and platelet count appears to be low, but the actual time saved by avoiding these tests in most patients in the era of point-of-service testing is unclear. Second, reading the brain CT scan by a radiologist. Several studies have shown that obtaining and reading CT scans are the major sources of IV tPA . . . [Full Text of this Article]

Related Article:

An Expedited Code Stroke Protocol Is Feasible and Safe

Justin A. Sattin, Scott E. Olson, Lin Liu, Rema Raman, and Patrick D. Lyden
Stroke 2006 37: 2935-2939. [Abstract] [Full Text] [PDF]

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