In a large observational study of patients who received tPA, parenchymal hemorrhage was no more frequent in patients with the most severe strokes than in those with more moderate strokes.
Some guidelines include severe stroke as a relative contraindication for tissue plasminogen activator (tPA) therapy, because of concern that rates of parenchymal hemorrhage will be higher in patients with severe stroke. These researchers used a European observational database of patients treated with tPA for ischemic stroke to compare rates of parenchymal hemorrhage between 868 patients with the most severe stroke (NIH Stroke Scale >25) and nearly 20,000 with more moderate stroke (NIH Stroke Scale 15–25) treated in 793 centers between 2002 and 2013.
Patients with very severe strokes were older, had more comorbidities, and were more likely to have posterior circulation stroke and to present obtunded or comatose. In addition, patients with ver…
Reviewing Author
DisclosuresRoyaltiesUpToDate
Grant/Research SupportEunice Kennedy Shriver National Institute of Child Health and Human Development; MINDSOURCE
Editorial BoardsThe Quarterly Update: Reviews of Current Child Abuse Medical Research; Child Abuse & Neglect: The International Journal
Leadership Positions in Professional SocietiesThe Helfer Society (Executive Committee Member)
DisclosuresRoyaltiesUpToDate
Grant/Research SupportEunice Kennedy Shriver National Institute of Child Health and Human Development; MINDSOURCE
Editorial BoardsThe Quarterly Update: Reviews of Current Child Abuse Medical Research; Child Abuse & Neglect: The International Journal
Leadership Positions in Professional SocietiesThe Helfer Society (Executive Committee Member)