Changing contraindications for t-PA in acute stroke: review of 20 years since NINDS.
When intravenous (IV) tissue-type plasminogen activator (t-PA) was originally approved by the Food and Drug Administration (FDA) for acute ischemic stroke (AIS) in 1996, there was a lengthy list of contraindications. In the 19 years since the approval of t-PA for AIS, it has been used off label and in patients with those contraindications. In February 2015, the list of contraindications for IV t-PA in AIS was revised and several of the previous contraindications were removed. As only 4 % of patients with ischemic stroke receive treatment with IV t-PA, these changes increase the number of patients eligible for treatment. Anytime there is a significant change in the indications and treatment paradigm with a medication, there can be some resistance to the adaptation of the change into physician's treating habits. We seek to review what the changes to t-PA contraindications are, how they came about, as well as the literature on the previously off-label and currently off-label use of IV t-PA for patients with AIS.
Illinois Neurological Institute, OSF Saint Francis Medical Center Comprehensive Stroke Center, 530 NE Glen Oak Ave, Peoria, IL, 61637, USA, sarah.parker@osfhealthcare.org.
Sarah
S
Parker
Yasmin
Y
Ali
D002545:Brain Ischemia / Q000188:drug therapy*; D000075202:Contraindications; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D055825:National Institute of Neurological Disorders and Stroke (U.S.); D056687:Off-Label Use / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D020521:Stroke / Q000188:drug therapy / Q000517:prevention & control*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014481:United States
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator