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Intravenous Tissue Plasminogen Activator Can Be Safely Given without Complete Blood Count Results Back.

Dong Y, Yang L, Ren J, Nair DS, Parker S, Jahnel JL, Swanson-Devlin TG, Beck JM, Mathews M, McNeil CJ, Ling Y, Cheng X, Gao Y, Dong Q, Wang DZ - PLoS ONE (2015)

Bottom Line: Normal platelet count was found in 98.8% patients after tPA was given.A significantly shorter door to needle interval (DTN) was found in the group without CBC resulted.The door to needle intervals can be significantly reduced.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Huashan Hospital, State Key of Laboratory of Neurobiology, Fudan University at Shanghai, Shanghai, China; INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.

ABSTRACT

Introduction: It is well known that the efficacy of intravenous (i.v.) tissue plasminogen activator (tPA) is time-dependent when used to treat patients with acute ischemic strokes.

Aim: Our study examines the safety issue of giving IV tPA without complete blood count (CBC) resulted.

Materials and methods: This is a retrospective observational study by examining the database from Huashan Hospital in China and OSF/INI Comprehensive Stroke Center in United States. Patient data collected included demographics, occurrence of symptomatic intracranial hemorrhage, door to needle intervals, National Institute of Health Stroke Scale scores on admission, CBC results on admission and follow-up modified Rankin Scale scores. Linear regression and multivariable logistic regression analysis were used to identify factors that would have an impact on door-to-needle intervals.

Results: Our study included 120 patients from Huashan Hospital and 123 patients from INI. Among them, 36 in Huashan Hospital and 51 in INI received i.v. tPA prior to their CBC resulted. Normal platelet count was found in 98.8% patients after tPA was given. One patient had thrombocytopenia but no hemorrhagic event. A significantly shorter door to needle interval (DTN) was found in the group without CBC resulted. There was also a difference in treatment interval between the two hospitals. Door to needle intervals had a strong correlation to onset to treatment intervals and NIHSS scores on admission.

Conclusion: In patients presented with acute ischemic stroke, the risk of developing hemorrhagic event is low if i.v. tPA is given before CBC has resulted. The door to needle intervals can be significantly reduced.

No MeSH data available.


Related in: MedlinePlus

Different DTN distributions between with/without CBC before tPA.DTN = door to needle intervals, CBC = complete blood count, tPA = tissue plasminogen activator; INI = Illinois Neurological Institute/OSF Comprehensive stroke center.
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pone.0131234.g001: Different DTN distributions between with/without CBC before tPA.DTN = door to needle intervals, CBC = complete blood count, tPA = tissue plasminogen activator; INI = Illinois Neurological Institute/OSF Comprehensive stroke center.

Mentions: In the logistic regression analysis, DTN interval within 60 minutes would be more likely reachable without a CBC result back (OR 0.25, 95%CI 0.12–0.50). Patients presented with milder symptoms (OR 1.72, 95%CI 1.10–2.68, p = 0.018) or treated at INI (OR 2.38, 95%CI 1.14–4.96) had shorter DTN intervals. Also, those who had been treated within the standard DTN interval (OR 1.22, 95%CI 1.02–1.46) had greater chance to achieve better outcome (mRS 0–1) (Fig 1 and Table 3).


Intravenous Tissue Plasminogen Activator Can Be Safely Given without Complete Blood Count Results Back.

Dong Y, Yang L, Ren J, Nair DS, Parker S, Jahnel JL, Swanson-Devlin TG, Beck JM, Mathews M, McNeil CJ, Ling Y, Cheng X, Gao Y, Dong Q, Wang DZ - PLoS ONE (2015)

Different DTN distributions between with/without CBC before tPA.DTN = door to needle intervals, CBC = complete blood count, tPA = tissue plasminogen activator; INI = Illinois Neurological Institute/OSF Comprehensive stroke center.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492952&req=5

pone.0131234.g001: Different DTN distributions between with/without CBC before tPA.DTN = door to needle intervals, CBC = complete blood count, tPA = tissue plasminogen activator; INI = Illinois Neurological Institute/OSF Comprehensive stroke center.
Mentions: In the logistic regression analysis, DTN interval within 60 minutes would be more likely reachable without a CBC result back (OR 0.25, 95%CI 0.12–0.50). Patients presented with milder symptoms (OR 1.72, 95%CI 1.10–2.68, p = 0.018) or treated at INI (OR 2.38, 95%CI 1.14–4.96) had shorter DTN intervals. Also, those who had been treated within the standard DTN interval (OR 1.22, 95%CI 1.02–1.46) had greater chance to achieve better outcome (mRS 0–1) (Fig 1 and Table 3).

Bottom Line: Normal platelet count was found in 98.8% patients after tPA was given.A significantly shorter door to needle interval (DTN) was found in the group without CBC resulted.The door to needle intervals can be significantly reduced.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Huashan Hospital, State Key of Laboratory of Neurobiology, Fudan University at Shanghai, Shanghai, China; INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.

ABSTRACT

Introduction: It is well known that the efficacy of intravenous (i.v.) tissue plasminogen activator (tPA) is time-dependent when used to treat patients with acute ischemic strokes.

Aim: Our study examines the safety issue of giving IV tPA without complete blood count (CBC) resulted.

Materials and methods: This is a retrospective observational study by examining the database from Huashan Hospital in China and OSF/INI Comprehensive Stroke Center in United States. Patient data collected included demographics, occurrence of symptomatic intracranial hemorrhage, door to needle intervals, National Institute of Health Stroke Scale scores on admission, CBC results on admission and follow-up modified Rankin Scale scores. Linear regression and multivariable logistic regression analysis were used to identify factors that would have an impact on door-to-needle intervals.

Results: Our study included 120 patients from Huashan Hospital and 123 patients from INI. Among them, 36 in Huashan Hospital and 51 in INI received i.v. tPA prior to their CBC resulted. Normal platelet count was found in 98.8% patients after tPA was given. One patient had thrombocytopenia but no hemorrhagic event. A significantly shorter door to needle interval (DTN) was found in the group without CBC resulted. There was also a difference in treatment interval between the two hospitals. Door to needle intervals had a strong correlation to onset to treatment intervals and NIHSS scores on admission.

Conclusion: In patients presented with acute ischemic stroke, the risk of developing hemorrhagic event is low if i.v. tPA is given before CBC has resulted. The door to needle intervals can be significantly reduced.

No MeSH data available.


Related in: MedlinePlus