Pennsylvania comprehensive @entity64 center collaborative: Statement on the recently updated IV rt-PA prescriber information for acute XXXX .

@entity1 @entity410 @entity64 @entity548 @entity4053 @entity1188 @entity6236 @entity385
OBJECTIVE: Recently, the FDA guidelines regarding the eligibility of @entity1 with acute @entity385 to receive IV rt-PA have been modified and are not in complete accord with the latest AHA/ASA guidelines. The resultant differences may result in discrepancies in @entity1 selection for intravenous thrombolysis. METHODS: Several comprehensive @entity64 centers in the state of Pennsylvania have undertaken a collaborative effort to clarify and unify our own recommendations regarding how to reconcile these different guidelines. RESULTS: @entity410 at onset of @entity64 , small previous strokes that are subacute or chronic, multilobar @entity1188 involving more than one third of the middle cerebral artery territory on CT scan, @entity4053 , minor or rapidly improving symptoms should not be considered as contraindications for intravenous thrombolysis. It is recommended to follow the AHA/ASA guidelines regarding blood pressure management and @entity548 diathesis. @entity1 receiving @entity6236 inhibitors and direct thrombin inhibitors within the preceding 48h should be excluded from receiving IV rt-PA. CT angiography is effective in identifying candidates for endovascular therapy. Consultation with and/or transfer to a comprehensive @entity64 center should be an option where indicated. @entity1 should receive IV rt-PA up to 4.5h after the onset of @entity64 . CONCLUSIONS: The process of identifying @entity1 who will benefit the most from IV rt-PA is still evolving. Considering the rapidity with which @entity1 need to be evaluated and treated, it remains imperative that systems of care adopt protocols to quickly gather the necessary data and have access to expert consultation as necessary to facilitate best practices.
