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Expo stroke

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Expo stroke

  1. 1. RAUL E. PORRAS SERNAMR1 MEDICINA DE EMERGENCIAS Y DESASTRES
  2. 2. FISIOPATOLOGIA
  3. 3. Inclusion and Exclusion Characteristics of PatientsWith Ischemic Stroke Who Could BeTreatedWith IV rtPAWithin 3 Hours From Symptom OnsetInclusion criteria• Diagnosis of ischemic stroke causingmeasurable neurological deficit• Onset of symptoms <3 hours beforebeginning treatment• Aged ≥18 years
  4. 4. Inclusion and Exclusion Characteristics of PatientsWith Ischemic Stroke Who Could BeTreatedWith IV rtPAWithin 3 Hours From Symptom OnsetExclusion criteria• Significant head trauma or prior stroke in previous 3months• Symptoms suggest subarachnoid hemorrhage• Arterial puncture at noncompressible site in previous 7days• History of previous intracranial hemorrhage• Intracranial neoplasm, arteriovenous malformation, oraneurysm• Recent intracranial or intraspinal surgery
  5. 5. Inclusion and Exclusion Characteristics of PatientsWith Ischemic Stroke Who Could BeTreatedWith IV rtPAWithin 3 Hours From Symptom OnsetExclusion Criteria• Elevated blood pressure (systolic >185 mm Hg ordiastolic >110 mm Hg)• Active internal bleeding• Acute bleeding diathesis, including but not limited to• Platelet count <100 000/mm3• Heparin received within 48 hours, resulting inabnormally elevated aPTT• greater than the upper limit of normal• Current use of anticoagulant with INR >1.7 or PT >15seconds
  6. 6. Inclusion and Exclusion Characteristics of PatientsWith Ischemic Stroke Who Could BeTreatedWith IV rtPAWithin 3 Hours From Symptom OnsetExclusion Criteria• Current use of direct thrombin inhibitors or directfactor Xa inhibitors with• elevated sensitive laboratory tests (such as aPTT, INR,platelet count, and• ECT;TT; or appropriate factor Xa activity assays)• Blood glucose concentration <50 mg/dL (2.7 mmol/L)• CT demonstrates multilobar infarction (hypodensity>1/3 cerebral hemisphere)
  7. 7. Inclusion and Exclusion Characteristics of PatientsWith Ischemic Stroke Who Could BeTreatedWith IV rtPAWithin 3 Hours From Symptom OnsetRelative exclusion criteria• Recent experience suggests that under somecircumstances—with careful consideration andweighting of risk to benefit—patients mayreceive fibrinolytic therapy despite 1 or morerelative contraindications. Consider risk tobenefit of IV rtPA administration carefully if anyof these relative contraindications are present:

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