Exclusion criteria for intravenous thrombolysis in stroke mimics: an observational study

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dc.contributor.authorBrunser, Alejandro
dc.contributor.authorIllanes, Sergio
dc.contributor.authorLavados, Pablo
dc.contributor.authorMuñoz, Paula
dc.contributor.authorCarcamo, Daniel
dc.contributor.authorHoppe, Arnold
dc.contributor.authorOlavarría, Verónica
dc.contributor.authorDelgado, Iris
dc.contributor.authorDiaz, Violeta
dc.date.accessioned2017-04-11T14:05:34Z
dc.date.available2017-04-11T14:05:34Z
dc.date.issued2013
dc.description.abstractBACKGROUND: Stroke mimics (SMs) are frequent in emergency departments (EDs), but are treated infrequently with intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis. We aimed at identifying the factors that lead to the exclusion of SMs from thrombolytic therapy. METHODS: Consecutive patients presenting to the ED between December 2004 and March 2011 with symptoms that suggested acute ischemic stroke were included. RESULTS: Eight hundred forty-two patients were included in this study; 113 (13.4%) were considered SMs; these patients were younger (P = .01), more frequently diabetic (P = .001), arrived later to the ED (P = .03), had lower National Institutes of Health Stroke Scale scores (P < .001), and higher frequencies of negative diffusion-weighted imaging studies (P = .002). The most common causes of cases of SM were toxic metabolic disorders (n = 34 [30.1%]) and seizures (n = 22 [19.5%]). The most frequent cause of consultation was aphasia (n = 43 [37.6%]). SM patients had a total of 152 contraindications for rt-PA, with 34 (30%) patients having >1 contraindication. The most frequent of these were being beyond the therapeutic window for thrombolysis (n = 96) and having deficits not measurable by the National Institutes of Health Stroke Scale or very mild symptoms before the start of rt-PA (n = 37). Twenty-four (21.2%) patients had both contraindications simultaneously. Two patients (1.76%) in the SM group were candidates for rt-PA but did not receive this treatment because they or their family rejected it. Of 729 stroke patients, 87 (11.9%) did receive rt-PA. CONCLUSIONS: SM patients frequently had exclusion criteria for systemic thrombolysis, the most frequent being presenting beyond the established thrombolytic window.
dc.format.extent6
dc.identifier.citationJ Stroke Cerebrovasc Dis. 2013 Oct;22(7):1140-1145
dc.identifier.urihttp://hdl.handle.net/11447/1125
dc.identifier.urihttp://doi.org/10.1016/j.jstrokecerebrovasdis.2012.10.019
dc.language.isoen_US
dc.publisherElsevier
dc.subjectStroke
dc.subjectstroke mimics
dc.subjectthrombolysis
dc.titleExclusion criteria for intravenous thrombolysis in stroke mimics: an observational study
dc.typeArtículo

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