ACS Stroke Sepsis

Cincinnati Stroke Program

tPA Criteria

Inclusion Criteria

  1. Age: >=18 yo
  2. Clinical Diagnosis of Stroke
  3. Onset <180 minutes

Medical History Exclusions

  1. Current use of anticoagulants and INR >1.5
  2. Use of Heparin (<48hrs) and PTT prolonged
  3. Hx of CVA in past 3 mos
  4. Hx of serious head injury in past 3 mos
  5. Major surgery, biopsy of organ or trauma in past 14 days
  6. Hx of any previous ICH
  7. Hx of intracranial CA, AVM or aneurysm
  8. Hx of Seizure at onset of CVA
  9. Hx of GI or urinary bleed in past 21 days
  10. Hx of MI in past 3 mos.
  11. Hx of pregnancy or parturition in past 30 days
  12. Hx of hereditary/acquired abnormal hemostasis
  13. Lumbar puncture in past 7 days
  14. Arterial puncture at non-compressible site in past 30 days

Clinical History Exclusions

  1. Rapidly improving neurological Sx
  2. Isolated mild neurological Sx or NIHSS <4 and normal speech/visual fields
  3. Presentation suggesting SAH despite normal CT
  4. Pretreatment HTN: SBP >=185 mmHg or DBP >=110mmHg
  5. Presumed septic embolus (stroke with fever)
  6. Glucose <50 mg/dl
  7. Platelets <100,000/mm
  8. Clinical presentation suggesting aortic dissection
  9. Head CT suggesting intracranial hemmorrhage of any type

Links

tPA Dosing Calculator

References

Harwood-Nuss' Clinical Practice of Emergency Medicine Editor: Wolfson, AB. LWW 2005.