Tissue-type plasminogen activator for acute ischemic stroke
Institute for Clinical Systems Improvement
Record ID 32005000317
English
Authors' objectives:
This review aims to assess the available evidence on tissue-type plasminogen activator for acute ischemic stroke.
Authors' recommendations:
With regard to tissue-type plasminogen activator for acute ischemic stroke, the ICSI Technology Assessment Committee finds the following:
For select patients with a clear diagnosis of ischemic stroke, administration of intravenous rt-PA (0.9 mg/kg to a maximum of 90 mg) is effective in reducing neurologic and functional deficits if administered within three hours of the onset of symptoms. Other patient selection criteria include an age of 18 years or older, no contraindications to IV rt-PA treatment on CT scan (such as intracranial hemorrhage, sulcal edema, hemispheric swelling, or large areas of low attenuation consistent with acute infarction), and the application of inclusion and exclusion criteria proposed in the NINDS trial (NINDS rt-PA Study Group, 1995; further details are specified under the headings Contraindications and Potential Uses) (Conclusion Grade II).
The evidence supports the conclusion that in appropriately selected patients with acute ischemic stroke the potential benefits of IV rt-PA outweigh the treatment-related risk of hemorrhage.
Intravenous rt-PA for acute stroke should only be utilized if the medical care providers have expertise, or access to expertise, in making a diagnosis of stroke, evaluating computed imaging studies of the brain, controlling hypertension, and diagnosing and managing possible intracranial and systemic bleeding complications of thrombolytic therapy. Facilities and staff must be available to aggressively monitor a patient's neurologic and hemodynamic parameters in an intensive care unit or a stroke unit following administration of the agent, as outlined in the NINDS trial (NINDS rt-PA Study Group, 1995).
Authors' methods:
Review
Details
Project Status:
Completed
URL for project:
http://www.icsi.org/knowledge/detail.asp?catID=107&itemID=615
Year Published:
2005
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
United States
MeSH Terms
- Acute Disease
- Brain Ischemia
- Stroke
- Tissue Plasminogen Activator
Contact
Organisation Name:
Institute for Clinical Systems Improvement
Contact Address:
8009 34th Avenue South, Suite 1200, Bloomington, MN, USA. Tel: +1 952 814 7060; Fax: +1 952 858 9675
Contact Name:
icsi.info@icsi.org
Contact Email:
icsi.info@icsi.org
Copyright:
Institute for Clinical Systems Improvement (ICSI)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.