Neurosurgery Blog: Etiologies of Neurologic Deterioration Following Intravenous Thrombolysis for Acute Ischemic Stroke. (P3.106)

Friday, April 11, 2014

Etiologies of Neurologic Deterioration Following Intravenous Thrombolysis for Acute Ischemic Stroke. (P3.106)

Neurology recent issues

OBJECTIVE: To identify tPA-specific clinical indications for transfer to an intensive care unit (ICU) in acute ischemic stroke (AIS) patients following intravenous (IV) thrombolysis.BACKGROUND: Caring for patients with AIS in dedicated stroke units has been shown to improve outcomes. IV thrombolysis with rtPA is the standard of care. However, data addressing the immediate disposition in post-thrombolysis patients are sparse. While several retrospective reviews identified improved outcomes in some groups of post-thrombolysis patients admitted to ICU, these were not predicted by the initial NIH Stroke Scale. Alternatively, it has been shown that bypassing ICU lowers hospitalization costs without adversely affecting outcomes. To our knowledge, there are no systematic attempts to identify specific complications necessitating escalation of care with ICU monitoring in the post-thrombolysis patients.METHODS: Medical records of patients admitted to the dedicated stroke unit in our hospital with the diagnosis of AIS who have received IV rtPA were identified using ICD-9 codes. Hospital courses were reviewed to select those patients requiring transfer to the ICU. The indications for transfer were abstracted.RESULTS: 35 records met the analysis criteria. Fourteen patients initially admitted to the stroke unit were transferred to the ICU - 8 for respiratory failure and 6 for alteration of consciousness. None of the respiratory failure patients had any hemorrhagic transformation identified on CT of the brain. Two of the patients transferred for alteration of consciousness had small areas of hemorrhagic conversion within the infarcted area, without associated worsening of edema or midline shift when compared to initial scans.CONCLUSIONS: Clinical deterioration in patients admitted to the dedicated stroke unit following IV thrombolysis is infrequently attributable to tPA complications. This suggests that post-thrombolysis patients can be safely managed on the dedicated stroke unit, since their complications are not likely to differ from the non-thrombolysed group.

Disclosure: Dr. Perchuk has nothing to disclose.

Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P3.106?rss=1