Table 2.
Number and percentage of neurologists who would administer intravenous tissue plasminogen activator (IV-tPA) in the presence of each exclusion criterion.
| Criteria for the question “Which of the potential IV-tPA exclusion criteria (based on 2015 AHA/ASA scientific statement or tPA package insert) WOULD NOT necessarily prevent you from administering IV-tPA to a patient with a perceived disabling stroke (provided other inclusion/exclusion criteria are met)?” ∗Multiple answers allowed | Number of responses (%), total N = 81 |
|---|---|
| None. I do not “bend” any of the guideline exclusion criteria | 8 (9.9) |
| Minor stroke (NIHSS < 5) | 40 (49.4) |
| Rapidly improving stroke symptoms | 24 (29.6) |
| Ischemic stroke within 3 months | 25 (30.9) |
| Significant head trauma within 3 months | 9 (11.1) |
| Seizure at onset | 37 (45.7) |
| Intracranial or intraspinal surgery in the prior 3 months | 11 (13.6) |
| Blood pressure > 185/110 mm Hg despite appropriate treatment efforts to control it | 11 (13.6) |
| Current use of anticoagulant with INR > 1.7 or PT > 15 | 10 (12.4) |
| Receiving heparin within 48 hours with aPTT value > 40 (abnormal) | 6 (7.4) |
| Receiving direct thrombin inhibitor or factor Xa inhibitor within 48 hours with normal coagulation profile (PT, PTT, INR, platelet count, clotting time, thrombin time, factor Xa activity assays) | 12 (14.8) |
| Receiving direct thrombin inhibitor or factor Xa inhibitor within 48 hours with unknown coagulation profile (PT, PTT, INR, platelet count, clotting time, thrombin time, factor Xa activity assays) | 6 (7.4) |
| Receiving direct thrombin inhibitor or factor Xa inhibitor within 48 hours with abnormal coagulation profile (PT, PTT, INR, platelet count, clotting time, thrombin time, factor Xa activity assays) | 6 (7.4) |
| Received therapeutic LMWH within 24 hours | 4 (4.9) |
| Major surgery within 14 days | 15 (18.5) |
| Major extracranial trauma within 14 days | 12 (14.8) |
| Active internal bleeding | 9 (11.1) |
| Previous ICH | 15 (18.5) |
| Symptoms suggestive of subarachnoid hemorrhage (SAH) | 6 (7.4) |
| Intracranial unruptured unsecured aneurysm | 11 (13.6) |
| Intracranial remotely ruptured, secured aneurysm | 13 (16.1) |
| Platelet count < 100,000 | 10 (12.4) |
| CT showing hypodensity > 1/3 of the cerebral hemisphere | 12 (14.8) |
| ST elevated MI in previous 3 months | 11 (13.6) |
| NSTEMI in previous 3 months | 17 (21.0) |
| Gastrointestinal hemorrhage in previous 21 days | 13 (16.1) |
| Genitourinary hemorrhage in previous 21 days | 11 (13.6) |
| Glucose < 50 mg/dl (deficits persist after glucose correction) | 12 (14.8) |
| Known brain tumor | 6 (7.4) |
| Intracranial AVM (arteriovenous malformation) | 9 (11.1) |
| Arterial puncture at a noncompressible site within 7 days | 11 (13.6) |
| Pregnancy | 24 (29.6) |