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Shorter Intensive Care Unit Stays?
- Source :
- Stroke. 49:1521-1524
- Publication Year :
- 2018
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2018.
-
Abstract
- Background and Purpose— Symptomatic intracranial hemorrhage (sICH) is a life-threatening complication after treatment with intravenous tPA (tissue-type plasminogen activator) for acute stroke. Currently, patients are monitored for sICH in a neurocritical care unit or intensive care unit-like setting for 24 hours post-treatment—a costly and resource intensive practice. Because the half-life of tPA is much shorter than 24 hours, it is possible that the majority of patients do not require such intensive monitoring. In this study, we evaluate the time period of the highest risk for sICH post-tPA. Methods— All patients receiving intravenous tPA for acute stroke between 2004 and 2017 at our institution were prospectively followed for sICH for 36 hours after treatment. The mean time from tPA administration to hemorrhage was calculated. Additional data were collected regarding: patient demographics, medical variables, and stroke characteristics. Variables significant in univariate analysis were entered into multivariable logistic regression models to determine factors associated with symptomatic hemorrhage. Results— Three hundred eighty-five patients were administered intravenous tPA. Twenty-one (5.5%) developed sICH. The mean time from administration to hemorrhage was 8.5 hours. Greater than 80% of sICHs occurred before 12 hours post-treatment. The only variable significantly associated with sICH was combination therapy (intravenous tPA and intra-arterial thrombectomy). Conclusions— sICH associated with the administration of intravenous tPA typically occurs within the first 12 hours of treatment. Longer monitoring in an intensive care unit-like setting may be unnecessary for most individuals.
- Subjects :
- Adult
Male
Combination therapy
030204 cardiovascular system & hematology
Brain Ischemia
law.invention
03 medical and health sciences
0302 clinical medicine
Fibrinolytic Agents
Risk Factors
law
Intensive care
Humans
Medicine
Stroke
Aged
Aged, 80 and over
Advanced and Specialized Nursing
Univariate analysis
business.industry
Neurointensive care
Middle Aged
medicine.disease
Intensive care unit
Intensive Care Units
Tissue Plasminogen Activator
Anesthesia
Female
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
Complication
Intracranial Hemorrhages
Plasminogen activator
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15244628 and 00392499
- Volume :
- 49
- Database :
- OpenAIRE
- Journal :
- Stroke
- Accession number :
- edsair.doi.dedup.....584fc2b2961054fdcbfea38eeadbc128