Safety of intravenous tissue plasminogen activator administration with computed tomography evidence of prior infarction

Michael J. Lyerly, J. Thomas Houston, Amelia K. Boehme, Karen C. Albright, Reza Bavarsad Shahripour, Paola Palazzo, Muhammed Alvi, Pawan Rawal, Niren Kapoor, April Sisson, Anne Alexandrov, Andrei Alexandrov

Research output: Contribution to journalArticle

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Abstract

Background Prior stroke within 3 months excludes patients from thrombolysis; however, patients may have computed tomography (CT) evidence of prior infarct, often of unknown time of origin. We aimed to determine if the presence of a previous infarct on pretreatment CT is a predictor of hemorrhagic complications and functional outcomes after the administration of intravenous (IV) tissue plasminogen activator (tPA). Methods We retrospectively analyzed consecutive patients treated with IV tPA at our institution from 2009-2011. Pretreatment CTs were reviewed for evidence of any prior infarct. Further review determined if any hemorrhagic transformation (HT) or symptomatic intracerebral hemorrhage (sICH) were present on repeat CT or magnetic resonance imaging. Outcomes included sICH, any HT, poor functional outcome (modified Rankin Scale score of 4-6), and discharge disposition. Results Of 212 IV tPA-treated patients, 84 (40%) had evidence of prior infarct on pretreatment CT. Patients with prior infarcts on CT were older (median age, 72 versus 65 years; P =.001) and had higher pretreatment National Institutes of Health Stroke Scale scores (median, 10 versus 7; P =.023). Patients with prior infarcts on CT did not experience more sICH (4% versus 2%; P =.221) or any HT (18% versus 14%; P =.471). These patients did have a higher frequency of poor functional outcome at discharge (82% versus 50%; P <.001) and were less often discharged to home or inpatient rehabilitation center (61% versus 73%; P =.065). Conclusions Visualization of prior infarcts on pretreatment CT did not predict an increased risk of sICH in our study and should not be viewed as a reason to withhold systemic tPA treatment after clinically evident strokes within 3 months were excluded.

Original languageEnglish (US)
Pages (from-to)1657-1661
Number of pages5
JournalJournal of Stroke and Cerebrovascular Diseases
Volume23
Issue number6
DOIs
StatePublished - Jan 1 2014

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Tissue Plasminogen Activator
Infarction
Tomography
Safety
Cerebral Hemorrhage
Stroke
Rehabilitation Centers
National Institutes of Health (U.S.)
Intravenous Administration
Inpatients
Magnetic Resonance Imaging

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Safety of intravenous tissue plasminogen activator administration with computed tomography evidence of prior infarction. / Lyerly, Michael J.; Houston, J. Thomas; Boehme, Amelia K.; Albright, Karen C.; Bavarsad Shahripour, Reza; Palazzo, Paola; Alvi, Muhammed; Rawal, Pawan; Kapoor, Niren; Sisson, April; Alexandrov, Anne; Alexandrov, Andrei.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 23, No. 6, 01.01.2014, p. 1657-1661.

Research output: Contribution to journalArticle

Lyerly, Michael J. ; Houston, J. Thomas ; Boehme, Amelia K. ; Albright, Karen C. ; Bavarsad Shahripour, Reza ; Palazzo, Paola ; Alvi, Muhammed ; Rawal, Pawan ; Kapoor, Niren ; Sisson, April ; Alexandrov, Anne ; Alexandrov, Andrei. / Safety of intravenous tissue plasminogen activator administration with computed tomography evidence of prior infarction. In: Journal of Stroke and Cerebrovascular Diseases. 2014 ; Vol. 23, No. 6. pp. 1657-1661.
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abstract = "Background Prior stroke within 3 months excludes patients from thrombolysis; however, patients may have computed tomography (CT) evidence of prior infarct, often of unknown time of origin. We aimed to determine if the presence of a previous infarct on pretreatment CT is a predictor of hemorrhagic complications and functional outcomes after the administration of intravenous (IV) tissue plasminogen activator (tPA). Methods We retrospectively analyzed consecutive patients treated with IV tPA at our institution from 2009-2011. Pretreatment CTs were reviewed for evidence of any prior infarct. Further review determined if any hemorrhagic transformation (HT) or symptomatic intracerebral hemorrhage (sICH) were present on repeat CT or magnetic resonance imaging. Outcomes included sICH, any HT, poor functional outcome (modified Rankin Scale score of 4-6), and discharge disposition. Results Of 212 IV tPA-treated patients, 84 (40{\%}) had evidence of prior infarct on pretreatment CT. Patients with prior infarcts on CT were older (median age, 72 versus 65 years; P =.001) and had higher pretreatment National Institutes of Health Stroke Scale scores (median, 10 versus 7; P =.023). Patients with prior infarcts on CT did not experience more sICH (4{\%} versus 2{\%}; P =.221) or any HT (18{\%} versus 14{\%}; P =.471). These patients did have a higher frequency of poor functional outcome at discharge (82{\%} versus 50{\%}; P <.001) and were less often discharged to home or inpatient rehabilitation center (61{\%} versus 73{\%}; P =.065). Conclusions Visualization of prior infarcts on pretreatment CT did not predict an increased risk of sICH in our study and should not be viewed as a reason to withhold systemic tPA treatment after clinically evident strokes within 3 months were excluded.",
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T1 - Safety of intravenous tissue plasminogen activator administration with computed tomography evidence of prior infarction

AU - Lyerly, Michael J.

AU - Houston, J. Thomas

AU - Boehme, Amelia K.

AU - Albright, Karen C.

AU - Bavarsad Shahripour, Reza

AU - Palazzo, Paola

AU - Alvi, Muhammed

AU - Rawal, Pawan

AU - Kapoor, Niren

AU - Sisson, April

AU - Alexandrov, Anne

AU - Alexandrov, Andrei

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background Prior stroke within 3 months excludes patients from thrombolysis; however, patients may have computed tomography (CT) evidence of prior infarct, often of unknown time of origin. We aimed to determine if the presence of a previous infarct on pretreatment CT is a predictor of hemorrhagic complications and functional outcomes after the administration of intravenous (IV) tissue plasminogen activator (tPA). Methods We retrospectively analyzed consecutive patients treated with IV tPA at our institution from 2009-2011. Pretreatment CTs were reviewed for evidence of any prior infarct. Further review determined if any hemorrhagic transformation (HT) or symptomatic intracerebral hemorrhage (sICH) were present on repeat CT or magnetic resonance imaging. Outcomes included sICH, any HT, poor functional outcome (modified Rankin Scale score of 4-6), and discharge disposition. Results Of 212 IV tPA-treated patients, 84 (40%) had evidence of prior infarct on pretreatment CT. Patients with prior infarcts on CT were older (median age, 72 versus 65 years; P =.001) and had higher pretreatment National Institutes of Health Stroke Scale scores (median, 10 versus 7; P =.023). Patients with prior infarcts on CT did not experience more sICH (4% versus 2%; P =.221) or any HT (18% versus 14%; P =.471). These patients did have a higher frequency of poor functional outcome at discharge (82% versus 50%; P <.001) and were less often discharged to home or inpatient rehabilitation center (61% versus 73%; P =.065). Conclusions Visualization of prior infarcts on pretreatment CT did not predict an increased risk of sICH in our study and should not be viewed as a reason to withhold systemic tPA treatment after clinically evident strokes within 3 months were excluded.

AB - Background Prior stroke within 3 months excludes patients from thrombolysis; however, patients may have computed tomography (CT) evidence of prior infarct, often of unknown time of origin. We aimed to determine if the presence of a previous infarct on pretreatment CT is a predictor of hemorrhagic complications and functional outcomes after the administration of intravenous (IV) tissue plasminogen activator (tPA). Methods We retrospectively analyzed consecutive patients treated with IV tPA at our institution from 2009-2011. Pretreatment CTs were reviewed for evidence of any prior infarct. Further review determined if any hemorrhagic transformation (HT) or symptomatic intracerebral hemorrhage (sICH) were present on repeat CT or magnetic resonance imaging. Outcomes included sICH, any HT, poor functional outcome (modified Rankin Scale score of 4-6), and discharge disposition. Results Of 212 IV tPA-treated patients, 84 (40%) had evidence of prior infarct on pretreatment CT. Patients with prior infarcts on CT were older (median age, 72 versus 65 years; P =.001) and had higher pretreatment National Institutes of Health Stroke Scale scores (median, 10 versus 7; P =.023). Patients with prior infarcts on CT did not experience more sICH (4% versus 2%; P =.221) or any HT (18% versus 14%; P =.471). These patients did have a higher frequency of poor functional outcome at discharge (82% versus 50%; P <.001) and were less often discharged to home or inpatient rehabilitation center (61% versus 73%; P =.065). Conclusions Visualization of prior infarcts on pretreatment CT did not predict an increased risk of sICH in our study and should not be viewed as a reason to withhold systemic tPA treatment after clinically evident strokes within 3 months were excluded.

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U2 - 10.1016/j.jstrokecerebrovasdis.2014.01.011

DO - 10.1016/j.jstrokecerebrovasdis.2014.01.011

M3 - Article

VL - 23

SP - 1657

EP - 1661

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

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ER -