Abstract T P62: Safety Scans after Intravenous Thrombolytic Therapy Fail to Alter Course or Management

Abstract

Introduction: The risk of intracranial hemorrhage (ICH) following IV-rtPA is 20%, and symptomatic ICH is 6%. Due to this concern, many practitioners obtain a 24-hour safety image after administration of t-PA for acute ischemic stroke (AIS). We sought to determine whether 24-hour safety imaging influenced clinical management or outcomes Methods: We conducted a retrospective analysis of suspected AIS patients treated with IV t-PA at our medical center between January 2012 and February 2014. Medical records were reviewed for clinical decision-making, neurologic deterioration, and ICH. All patients were examined on admission by NIHSS-certified neurologists. Baseline characteristics were captured from a department database. A stepwise linear regression was used to identify variables predicting change in management and discharge modified Rankin scores (mRS). Results: Our study included 172 patients who received IV t-PA. After exclusion for endovascular treatment, clinical research trials that required follow-up imaging, and missing demographics, 116 patients were included in the final analysis. Neurologic deterioration was seen in 20 (17.2%) patients, intracranial hemorrhage was seen in 19 (16.3%) patients, and clinical management changed in 11 (9.4%) patients. Clinical deterioration was the only variable that predicted a change in management (logistic regression p<0.05). After adjusting for deterioration, neither 24-hour imaging nor presence of ICH predicted a change in management. Using a linear regression model, baseline NIHSS and clinical deterioration predicted mRS at discharge, whereas 24-hour imaging and change in clinical management did not (r 2 =0.43, p<0.001). Conclusion: Our data suggests frequent examination for neurologic deterioration is superior to 24-hour imaging in guiding clinical decision making. These findings should be investigated prospectively.