Episode 899: Thrombolytic Contraindications

Episode 899: Thrombolytic Contraindications

Contributor: Travis Barlock MD

Educational Pearls:

  • Thrombolytic therapy (tPA or TNK) is often used in the ED for strokes

  • Use of anticoagulants with INR > 1.7 or PT >15

    • Warfarin will reliably increase the INR

  • Current use of Direct thrombin inhibitor or Factor Xa inhibitor

    • aPTT/PT/INR are insufficient to assess the degree of anticoagulant effect of Factor Xa inhibitors like apixaban (Eliquis) and rivaroxaban (Xarelto)

  • Intracranial or intraspinal surgery in the last 3 months

    • Intracranial neoplasms or arteriovenous malformations also increase the risk of bleeding

  • Current intracranial or subarachnoid hemorrhage

    • History of intracranial hemorrhage from thrombolytic therapy also contraindicates tPA/TNK

  • Recent (within 21 days) or active gastrointestinal bleed

  • Hypertension

    • BP >185 systolic or >110 diastolic

    • Administer labetalol before thrombolytics to lower blood pressure

  • Timing of symptoms

    • Onset > 4.5 hours contraindicates tPA

  • Platelet count < 100,000

  • BGL < 50

    • Potential alternative explanation for stroke-like symptoms obviating need for thrombolytics

References

1. Fugate JE, Rabinstein AA. Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke. The Neurohospitalist. 2015;5(3):110-121. doi:10.1177/1941874415578532

2. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke a Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Vol 50.; 2019. doi:10.1161/STR.0000000000000211

Summarized by Jorge Chalit, OMSII | Edited by Jorge Chalit

Episoder(1144)

Episode 987: Cough Suppressants

Episode 987: Cough Suppressants

Contributor: Meghan Hurley, MD Educational Pearls:  OTC Medications Dextromethorphan (DM) Most common OTC cough suppressant Minimal efficacy: Little evidence that it shortens the duration or severit...

15 Des 20257min

Episode 986: Lateral Canthotomy in Emergency Settings

Episode 986: Lateral Canthotomy in Emergency Settings

Contributor: Taylor Lynch, MD Educational Pearls: What is orbital compartment syndrome, and how is it assessed in the emergency room? Orbital compartment syndrome (OCS) is an emergent ophthalmic cond...

8 Des 20254min

Episode 985: Amiodarone vs. Lidocaine

Episode 985: Amiodarone vs. Lidocaine

Contributor: Aaron Lessen, MD Educational Pearls: How do amiodarone and lidocaine work on the heart? Amiodarone Blocks potassium channels (Class III effect). Also blocks sodium and calcium channels....

8 Des 20252min

Episode 984: Fish Hooks

Episode 984: Fish Hooks

Contributor: Megan Hurley, MD Educational Pearls: Assess first: confirm the hook isn't near vital structures. Automatic subspecialty consult for eye involvement or proximity to carotid artery, radial...

24 Nov 20254min

Episode 983: Head-of-Bed Position in Large Vessel Occlusion Strokes

Episode 983: Head-of-Bed Position in Large Vessel Occlusion Strokes

Contributor: Aaron Lessen MD Educational Pearls:  Recent prospective randomized clinical trial assessed optimal head-of-bed positioning in patients with LVO 0º vs. 30º elevation Objective was to det...

18 Nov 20252min

Episode 982: Epistaxis Management

Episode 982: Epistaxis Management

Contributor: Meghan Hurley, MD Educational Pearls: 1. Initial Assessment Start with a physical examination: Determine if the bleed is anterior or posterior. Perform a primary survey: assess ai...

10 Nov 20256min

Episode 981: Electrical Burns

Episode 981: Electrical Burns

Contributor: Travis Barlock, MD Educational Pearls: Quick Statistics on Electrical Burns: Electrical burns compose roughly 2 to 9% of all burns that come into emergency departments. The majority of p...

3 Nov 20253min

Tox Talks 2025 Recap 1, Digoxin and Beta Blockers

Tox Talks 2025 Recap 1, Digoxin and Beta Blockers

Contributors: Preeya Prakash MD, Adam Greenhaw PharmD, Travis Barlock MD, and Jeffrey Olson MS4 In this episode, cardiologist Preeya Prakash and medical student Jeffrey Olson listen in as two cases ar...

29 Okt 202557min

Populært innen Vitenskap

fastlegen
tingenes-tilstand
rekommandert
jss
tomprat-med-gunnar-tjomlid
rss-rekommandert
forskningno
sinnsyn
rss-paradigmepodden
villmarksliv
fjellsportpodden
tidlose-historier
dekodet-2
diagnose
grunnstoffene
rss-nysgjerrige-norge
noen-har-snakket-sammen
nevropodden
vett-og-vitenskap-med-gaute-einevoll
rss-hundehuset