title: Intravenous Tissue Plasminogen Activator Can Be Safely Given without Complete Blood Count Results Back.
abstract: BACKGROUND
  It is well known that the efficacy of intravenous (i.v.) tissue plasminogen activator (tPA) is time-dependent when used to treat patients with acute ischemic strokes.
  
  
  OBJECTIVE
  Our study examines the safety issue of giving IV tPA without complete blood count (CBC) resulted.
  
  
  METHODS
  This is a retrospective observational study by examining the database from Huashan Hospital in China and OSF/INI Comprehensive Stroke Center in United States. Patient data collected included demographics, occurrence of symptomatic intracranial hemorrhage, door to needle intervals, National Institute of Health Stroke Scale scores on admission, CBC results on admission and follow-up modified Rankin Scale scores. Linear regression and multivariable logistic regression analysis were used to identify factors that would have an impact on door-to-needle intervals.
  
  
  RESULTS
  Our study included 120 patients from Huashan Hospital and 123 patients from INI. Among them, 36 in Huashan Hospital and 51 in INI received i.v. tPA prior to their CBC resulted. Normal platelet count was found in 98.8% patients after tPA was given. One patient had thrombocytopenia but no hemorrhagic event. A significantly shorter door to needle interval (DTN) was found in the group without CBC resulted. There was also a difference in treatment interval between the two hospitals. Door to needle intervals had a strong correlation to onset to treatment intervals and NIHSS scores on admission.
  
  
  CONCLUSIONS
  In patients presented with acute ischemic stroke, the risk of developing hemorrhagic event is low if i.v. tPA is given before CBC has resulted. The door to needle intervals can be significantly reduced.
authors.affiliation: Department of Neurology, Huashan Hospital, State Key of Laboratory of Neurobiology, Fudan University at Shanghai, Shanghai, China; INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
authors.forename: Yi
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Department of Neurology, Huashan Hospital, State Key of Laboratory of Neurobiology, Fudan University at Shanghai, Shanghai, China.
authors.forename: Lumeng
authors.initials: L
authors.lastname: Yang
authors.affiliation: Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
authors.forename: Jinma
authors.initials: J
authors.lastname: Ren
authors.affiliation: INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
authors.forename: Deepak S
authors.initials: DS
authors.lastname: Nair
authors.affiliation: INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Parker
authors.affiliation: INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Jahnel
authors.affiliation: INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
authors.forename: Teresa G
authors.initials: TG
authors.lastname: Swanson-Devlin
authors.affiliation: INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Beck
authors.affiliation: INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
authors.forename: Maureen
authors.initials: M
authors.lastname: Mathews
authors.affiliation: INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
authors.forename: Clayton J
authors.initials: CJ
authors.lastname: McNeil
authors.affiliation: Department of Neurology, Huashan Hospital, State Key of Laboratory of Neurobiology, Fudan University at Shanghai, Shanghai, China.
authors.forename: Yifeng
authors.initials: Y
authors.lastname: Ling
authors.affiliation: Department of Neurology, Huashan Hospital, State Key of Laboratory of Neurobiology, Fudan University at Shanghai, Shanghai, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Cheng
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Zhengzhou University at Henan, Zhengzhou, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Neurology, Huashan Hospital, State Key of Laboratory of Neurobiology, Fudan University at Shanghai, Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Dong
authors.affiliation: INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, United States of America.
authors.forename: David Z
authors.initials: DZ
authors.lastname: Wang
mesh_terms: D061605:Administration, Intravenous / Q000379:methods; D000368:Aged; D001772:Blood Cell Count / Q000379:methods; D001773:Blood Cells / Q000187:drug effects*; D001792:Blood Platelets / Q000187:drug effects; D002545:Brain Ischemia / Q000188:drug therapy; D002681:China; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy; D008297:Male; D010976:Platelet Count / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: C067262:PLAT protein, human; D010959:Tissue Plasminogen Activator