Telestroke Treatment With IV tPA: How Long Is the Window of Opportunity?
Treatment with IV tPA via telestroke services appears safe, effective in extended time frames.
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BOSTON – Findings presented at the 2017 American Academy of Neurology (AAN) Annual Meeting, April 22-28 in Boston, Massachusetts suggest that it is safe and effective to administer intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke via telemedicine 3 to 4.5 hours from when patients are last seen well..
“Telestroke has been successfully used to administer tPA, however, there is little data to support telestroke for IV thrombolysis administration in the extended time window of 3 hours to 4.5 hours,” wrote Ashutosh Jadhav, MD, PhD, from the University of Pittsburgh Medical Center, and colleagues.
The researchers performed a retrospective review of patients who received IV tPA via telestroke at University of Pittsburgh Medical Center from January 2014 to June 2016.
They compared those who received IV tPA through telestroke less than 3 hours since they were last seen well (LSW) (n=407; average time since LSW=122 minutes) with those who received IV tPA 3 to 4.5 hours since LSW (n=63; average time since LSW=210 minutes). The outcomes of interest were symptomatic intracerebral hemorrhage (sICH) and modified Rankin Scale scores (mRS).
The average National Institute of Health stroke score (NIHSS) upon admission for those administered IV tPA >3 hours since LSW was 10.5; the average NIHSS score for those given IV tPA 3 to 4.5 hours after LSW was 9.03. There was no significant difference between the >3 hour group and the 3 to 4.5 hour group in sICH (5% vs 2%, P >.05) and mRS (2.64 vs 2.63, P >.05).
“[These] data suggest that it is safe and efficacious to give IV tPA with telemedicine from 3 to 4.5 hours,” the researchers concluded.
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Steinberg A, Kenmuir C, Jovin T, Wechsler L, Jadhav A. Safety and efficacy of thrombolysis in telestroke for the extended time window. Presented at: 2017 American Academy of Neurology Annual Meeting. April 22-28, 2017; Boston, MA.