Joint Clinical Policy Urges Early Use of IV tPA in Patients with Ischemic Stroke

February 22, 2013

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Very early intervention with tPA for patients who are eligible for the treatment and are presenting early with symptoms of acute ischemic stroke can improve their chances of having good functional outcomes. The earlier you treat, the better the chance of having a good outcome.

This is the key message of a clinical policy co-developed by the AAN and the American College of Emergency Physicians (ACEP) that provides evidence-based recommendations regarding use of intravenous (IV) tPA for the management of acute ischemic stroke in the emergency department.  The AAN fully endorsed the document in December 2012, which was published online ahead of print on January 18, 2013, in the Annals of Emergency Medicine, ACEP's official clinical journal, and appeared in the February 2013 print issue.

The document was developed on the basis of a process that is substantially similar to the AAN's 2004 process for development of evidence-based guidelines and was mutually agreed upon by both organizations.

According to the document, evidence (high degree of clinical certainty) supports the practice of using IV tPA in patients with acute ischemic stroke (who can be treated within 3 hours after symptom onset and who meet National Institute of Neurological Disorders and Stroke inclusion/exclusion criteria) in order to improve their functional outcomes (Level A recommendation). Evidence (moderate degree of clinical certainty) supports the practice of using IV tPA in patients with acute ischemic stroke (who can be treated between 3 to 4.5 hours after symptom onset and who meet European Cooperative Acute Stroke Study inclusion/exclusion criteria) in order to improve their functional outcomes (Level B recommendation). Within either time window, earlier treatment appears to be more effective than later treatment.

Read the clinical policy and access PDF summaries for clinicians and patients. For more information, contact Julie Cox at jcox@aan.com or (612) 928-6069.