Abstract W P237: IV TPA Can be Safely Given Without CBC Results Back
Background: Reducing door to needle time when giving IV TPA is key to resolve ischemic stroke. Currently, precious time is wasted reviewing all inclusion and exclusion criteria for IV TPA, which were used during clinical trials. There is no evidence that harm has been done if these criteria are not followed. Simplifying the criteria may be safe and can shorten door to needle time significantly. Complete blood count (CBC) is one item that may not always be needed if stroke patient has no history of hematological disorder. While CBC and other labs can be obtained first, it may be safe that IV TPA can be given without CBC results are back.
Method: Data on all patients who received IV TPA before CBC resulted was tabulated and analyzed. Their demographic data, LOS, complications, and discharge destination were examined. Descriptive statistics were used.
Results: From 01/2012-07/2013, 547patients were directly admitted for ischemic stroke at our CSC and 86 (16%) received IV TPA. Among them, 51 (59%) had IV TPA prior to their CBC resulted. Their average age was 75 and 31 (60%) were female. Normal CBC was found in 50 (98%) patients later but 1(2%) had platelet count of 81,000. This patient had no hemorrhagic event and her stroke symptoms completely resolved by day two of admission. Overall, 22 (43%) went home, 4(7%) had symptomatic ICH despite they had normal CBC, 6(11%) went to rehabilitation, and 6(11%) died.
Conclusions: In patients presented with acute ischemic stroke who are candidates for IV TPA, it is safe to give IV TPA first before CBC results are available. This will reduce door to needle time by at least 20 minutes. Millions of brain cells can be saved. Therefore, having CBC results back is not essential when IV TPA is considered.
Author Disclosures: D. Wang: None. S. Parker: None. D. Nair: None. A. Talkad: None. C.J. McNeil: None. T. Swanson-Devlin: None. J. Beck: None. J.L. Jahnel: None.
- © 2014 by American Heart Association, Inc.