VascularNervousSystemDisorders-ArkansasSAVES：血管神经系统紊乱的阿肯色州省.pptVIP

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VascularNervousSystemDisorders-ArkansasSAVES：血管神经系统紊乱的阿肯色州省.ppt

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VascularNervousSystemDisorders-ArkansasSAVES：血管神经系统紊乱的阿肯色州省.ppt

Hyperacute Stroke Treatment:Inclusion and Exclusion Criteria Odds ratio of favorable outcome if t-PA is given: within 90 min of symptom onset= 2.81 (95% CI, 1.75-4.50) Within 90 and 180 min of symptom onset= 1.55 (95% CI, 1.12-2.15) Community registry study SITS-ISTR: frequency of favorable outcome is 56.3% (CI, 55.3-57%) T-PA Benefit T-PA Benefit 3 to 4.5 hour Odds ratio of excellent outcome= 1.40 (95% CI, 1.05-1.85) ECASS III trial odds ratio mRS 0-1: odds ratio 1.34 (95% CI, 1.02- 1.76) T-pa Risk Major risk is intracerebral hemorrhage with variable rates of occurrence 1.9% to 10% Risk of hemorrhage increases in proportion to degree to which the protocol is not followed Angioedema estimated to occur between 1.3 – 5.1% More associated with angiotensin converting enzyme inhibitor use Infarct involving the insular and frontal cortex Inclusion Criteria for Intravenous t-PA Diagnosis of ischemic stroke causing measurable neurological deficit Onset of symptoms 3hours before beginning treatment Onset time is defined as either the witnessed onset of symptoms or the time last known normal if symptom onset was not witnessed Aged 18 years Exclusion Criteria for Intravenous t-PA Significant head trauma or prior stroke in previous 3 months Small stroke within 3 months may be considered but should be included in risk discussion with patient or family member Symptoms suggest subarachnoid hemorrhage Arterial puncture at a noncompressible site in previous 7 days Exclusion Criteria for Intravenous t-PA History of previous intracerebral hemorrhage Intracranial neoplasm, arteriovenous malformation, aneurysm Recent intracranial or intraspinal surgery Elevated blood pressure (systolic 185 or diastolic 110mm Hg) Exclusion Criteria for Intravenous t-PA Active internal bleeding Acute bleeding diathesis, including but not limited to: Platelet count 100,00/mm Heparin received within 48 hours, resulting in abnormally elevated aPTT greater than the upper limit of normal Current use