Abstract T P58: TPA Contraindications have Little Impact on Thrombolysis Outcomes

Abstract

Treatment with tPA is effective in patients with acute ischemic stroke but is only given to ~4% of patients. Part of what limits the use of tPA in acute stroke is the list of recognized contraindications (CIs) to tPA. Many of these CIs have little or no evidence describing how they may affect the safety of tPA. At the OSF Saint Francis comprehensive stroke center we have relaxed our definition of who can qualify for tPA. Aggressively limiting what is considered a contraindication to tPA allows more patients to be treated safely and effectively. We reviewed 218 patients who received tPA at our center from July 2010 to July 2014 to determine how many had one of 19 recognized CIs. Admission and discharge NIHSS, discharge MRS, discharge disposition and symptomatic ICH rates were compared in patients with CIs and those without. Ninety (41%) of our patients were found to have one or more contraindication to tPA. There were a total of 157 CIs. The most common contraindication was NIHSS greater than 22 or less than 4 with 37 patients. The mean decrease in NIHSS from admission to discharge was 4 points in patients with CIs and those without CIs. There was no significant difference in the 43% of patients with CIs and the 42% of patients without CIs who had a good outcome on discharge defined as a discharge MRS of 0-2. There was no significant difference between the 64.8% of patients discharged to home or to rehab in the patients with CIs and the 66.1% of patients discharged to home or rehab who did not have CIs. There was also no significant difference between the 1% of patients with CIs who had symptomatic intracerebral hemorrhage and the 2% of patients without CIs with symptomatic intracerebral hemorrhage. When making the decision to treat acute ischemic stroke with tPA, the risks & benefits of treating vs not treating should be weighed as they apply to each individual patient. Given our findings, we feel there is evidence that many contraindications to tPA should have less weight when making such decisions. This may increase the number of eligible patients who would receive treatment for stroke.