Episode 899: Thrombolytic Contraindications
Emergency Medical Minute15 Apr 2024

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

Avsnitt(1146)

Podcast 856: ED Errors and Counterstudy

Podcast 856: ED Errors and Counterstudy

Contributor: Nicholas Tsipis, MD Educational Pearls: What study was Dr. Tsipis talking about? In December of 2022, the Agency for Healthcare Research and Quality (AHRQ) put out a study titled "Diagn...

19 Juni 20234min

Podcast 855: QT Intervals

Podcast 855: QT Intervals

​​Contributor: Travis Barlock MD Educational Pearls The QT interval represents phases 2 and 3 of ventricular plateau and repolarization, respectively. As the QT interval lengthens, more sodium an...

12 Juni 20234min

Mental Health Monthly #16: Psychosis in the ED Part II

Mental Health Monthly #16: Psychosis in the ED Part II

Contributors: Andrew White MD & Travis Barlock MD In this follow-up episode Dr. Andrew White, a practicing psychiatrist with an addiction medicine fellowship, and Dr. Travis Barlock, an emergency phys...

7 Juni 202324min

Episode 854: Tranq (xylazine) with Heroin

Episode 854: Tranq (xylazine) with Heroin

Contributor: Aaron Lessen, MD Educational Pearls: What is Tranq? Tranq is the street name for xylazine, a sedative drug typically used in veterinary medicine. Xylazine has recently emerged as a re...

5 Juni 20232min

Podcast 853: Critical Care Medications - Vasopressors

Podcast 853: Critical Care Medications - Vasopressors

Contributor: Travis Barlock MD Educational Pearls: Three categories of pressors: inopressors, pure vasoconstrictors, and inodilators Inopressors:  Epinephrine - nonselective beta- and alpha-adr...

29 Maj 20235min

Podcast 852: Angioedema After Thrombolysis

Podcast 852: Angioedema After Thrombolysis

Contributor: Aaron Lessen, MD Educational Pearls: What is thrombolysis? Thrombolysis is performed by administration of a medication that promotes the body's natural ability to break up clots. These ...

22 Maj 20232min

Podcast 851: High-Dose Nitroglycerin in SCAPE

Podcast 851: High-Dose Nitroglycerin in SCAPE

Contributor: Aaron Lessen MD Educational Pearls: SCAPE (Sympathetic Crashing Acute Pulmonary Edema), formerly known as flash pulmonary edema, is a life-threatening condition due to a sudden sympathet...

15 Maj 20233min

Podcast 850: Cardiac Arrest - Entertainment vs. Reality

Podcast 850: Cardiac Arrest - Entertainment vs. Reality

Contributor: Travis Barlock, MD Educational Pearls: Sudden Cardiac Arrest (SCA) is defined as when the heart suddenly stops beating. Immediate treatment for SCA includes Cardiopulmonary Resuscitation ...

8 Maj 20232min

Populärt inom Vetenskap

dumma-manniskor
svd-nyhetsartiklar
p3-dystopia
kapitalet-en-podd-om-ekonomi
allt-du-velat-veta
rss-ufo-bortom-rimligt-tvivel
det-morka-psyket
rss-vetenskapsradion
sexet
medicinvetarna
rss-vetenskapsradion-2
rss-experimentet
pojkmottagningen
dumforklarat
hacka-livet
rss-spraket
bildningspodden
rss-broccolipodden-en-podcast-som-inte-handlar-om-broccoli
rss-lara-fran-larda-en-fackbok-och-en-forfattare
intergalaktiskt