tPA - Practical Considerations for Real-Life Use - Dr. Asimos

1. TIME IS ESSENTIAL! Phase 3 & 4 IV tPA trial data and Phase 3 endovascular intervention data show a consistent association of improved stroke outcomes with earlier treatment.

2. The decision to withhold IV tPA treatment in the setting of mild or rapidly improving symptoms should be determined based on if any remaining deficits will be disabling for the given patient.

3. Randomized data suggest that isolated MCA occlusions respond similarly to either IV tPA or endovascular therapy.

4. The best available evidence suggests no absolute age cutoff for exclusion from IV tPA therapy within 3 hours of symptom onset.

5. Advanced age, hyperglycemia, and a high NIHSS (>20) increase the risk of hemorrhagic transformation for acute stroke treated with revascularization therapy.

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