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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

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Published on: January 18, 2018

Predicting abnormal coagulation in ischemic stroke: reducing delay in rt-PA use.

Rebecca F Gottesman¹, Janice Alt, Robert J Wityk

¹Cerebrovascular Division, Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

|November 15, 2006

Summary

Elevated prothrombin time (PT) and partial thromboplastin time (PTT) in stroke patients taking specific medications or on hemodialysis can be predicted. This allows for faster recombinant tissue-plasminogen activator (rt-PA) administration, improving stroke care.

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Area of Science:

Neurology
Hematology
Emergency Medicine

Background:

Recombinant tissue-plasminogen activator (rt-PA) is a critical treatment for acute ischemic stroke.
Normal prothrombin time (PT) and partial thromboplastin time (PTT) are prerequisites for rt-PA administration.
Delays in obtaining PT/PTT results can impede timely rt-PA treatment.

Purpose of the Study:

To identify predetermined risk factors for elevated PT/PTT in stroke patients.
To assess the feasibility of predicting elevated PT/PTT at emergency department triage.
To reduce delays in rt-PA administration for eligible stroke patients.

Main Methods:

Retrospective chart review of 365 stroke patients.
Analysis of predetermined risk factors including warfarin, heparin/heparinoid use, and hemodialysis.
Calculation of sensitivity and specificity for predicting elevated PT/PTT.

Main Results:

Elevated PT/PTT in stroke patients taking warfarin or heparin/heparinoid, or on hemodialysis, was predictable.
The identified risk factors demonstrated 100% sensitivity and 94.7% specificity.
Triage-based prediction of elevated PT/PTT is feasible.

Conclusions:

Predicting elevated PT/PTT at triage can expedite rt-PA administration in stroke patients.
This approach can potentially reduce treatment delays for eligible stroke patients.
Integrating PT/PTT risk assessment into triage protocols may improve stroke outcomes.