Is Tissue Plasminogen Activator Harmful in Patients Who Ultimately Do Not Have Acute Ischemic Stroke?

Deciding whether to administer intravenous (IV) tissue plasminogen activator (TPA) to a patient who presents with symptoms of acute ischemic stroke is often difficult, because the diagnosis must be made quickly with minimal information. As IV TPA is not without substantial risk, clinicians must carefully consider the certainty of their presumptive diagnosis of ischemic stroke versus a stroke mimic, such as seizure or migraine.

In a retrospective review of stroke registry patients, researchers evaluated the safety and outcomes of IV TPA in patients who ultimately received diagnoses for conditions other than acute ischemic stroke. Of 512 patients who were treated with IV TPA, 21% had alternative final diagnoses; 14% had stroke mimic (SM) syndr…