Contraindications to intravenous rtPA for acute stroke: A critical reappraisal

Abstract

Drs. Fugate and Rabinstein1 present a compelling discussion regarding the limitations of tissue plasminogen activator (tPA) use in the current guidelines, providing evidence that favors expanding the criteria to include patients now outside the guidelines. There is also a need to examine critically whether the guidelines include patients for whom there remains insufficient evidence to support use of tPA, specifically the young adult age group. The guidelines appear to recommend use in the 18 to 29 age group based chiefly upon the age criteria for inclusion in the NIH 1995 tPA study. A report by Kissela et al.2 relates that young adults aged 20 to 44 are 4.1% of the stroke population. Using the figure as a rough guide, the NIH study of 333 patients is likely to involve 13 patients age 20 to 44. The number of patients is too small to be conclusive. … Correspondence to: Fugate.Jennifer{at}mayo.edu