Abstract 65: Timing of Complications Related to Current Post tPA Protocol
The current clinical practice guidelines (CPG) based on the NINDS trial from 1995 recommend that vital signs and neuro checks are completed Q15 min x 2 hrs., Q 30 min x 6 hrs., Q 1 hour x 16 hrs. post administration of IV t-PA. The half-life (t½α) of Alteplase is <5 min, therefore the current vigilance of neurological assessments may not be necessary. The purpose of this study was to evaluate the timing of when a symptomatic intracranial hemorrhage (sICH) occured in relation to the administration of IV t-PA.
Results: A total of 569 patients who received IV t-PA were reviewed. Nine patients, with a mean age of 70 ± 17 years and mean NIHSS of 11, were diagnosed with a sICH within 36 hrs. post IV t-PA administration. The mean time of detecting sICH post IV t-PA administration was 294 minutes. The shortest time was 77 min and the longest time was 814 min (13 hrs and 34 min). The vast majority (77%) of the sICH complications were diagnosed in less than 6 hrs.
Conclusions: This analysis suggests that sICH occurs early in the course after administration of IV t-PA. Future guidelines may consider reducing the neurological assessment frequency after 12 hours from IV t-PA administration. Prospective controlled studies are required to validate these results.
Author Disclosures: K. Bryant: None. K. Anda: None. L. Busby: None. D. Camp: None. K. Connely: None. T. Westbrook: None. S. Zimmermann: None. R. Gupta: Consultant/Advisory Board; Modest; Stryker, Covidien, Rapid Medical. Other; Modest; Associate Editor Journal of Neuroimaging and Neurointerventional Surgery, Royalties UpToDate.
- © 2015 by American Heart Association, Inc.