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After a review of the current literature, it was clearly evident that the levels of evidence supporting individual exclusion criteria for intravenous alteplase vary widely. Several exclusionary criteria have already undergone extensive scientific study such as the clear benefit of alteplase treatment in elderly stroke patients, those with severe stroke, those with diabetes mellitus and hyperglycemia, and those with minor early ischemic changes evident on computed tomography. Some exclusions such as recent intracranial surgery are likely based on common sense and sound judgment and are unlikely to ever be subjected to a randomized, clinical trial to evaluate safety. Most other contraindications or warnings range somewhere in between. However, the differential impact of each exclusion criterion varies not only with the evidence base behind it but also the frequency of the exclusion within the stroke population, the probability of coexistence of multiple exclusion factors in a single patient, and the variation in practice among treating clinicians. |
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cerebrovascular accident
cerebrovascular accident,acute management of
cerebrovascular accident,thrombolytic agents in treatment
controversies in neurology
fibrinolytic agents
fibrinolytic agents,contraindications
fibrinolytic agents,exclusion criteria
fibrinolytic therapy,selection criteria
practice guidelines
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safety
treatment of neurologic disorder
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