Would you give TNK or IVT to a patient with proximal occlusion and an NIHSS of 0-3 (non-disabling)?
How about a distal occlusion? The patient was initially symptomatic but symptoms improved or mostly resolved.
Answer from: at Community Practice
For non-disabling stroke symptoms with an NIHSS 0-5, current AHA Guidelines recommend against IV thrombolysis. (Technically, TNK has not yet made it into the AHA Guidelines, but that's not the topic here). Of course, what is considered disabling is always a debate, but the PRISMS trial defined it as...
Comments
at Wellspan Health Excellent synopsis and I wholeheartedly agree.
at Cleveland Clinic Thank you, Dr. @Teitcher. I appreciate your though...
at UPMC Very helpful.
at Baylor College of Medicine There are lots of abbreviations being used. I woul...
at Cleveland Clinic NIHSS: National Institute of Health Stroke Scale
...
at Shaare Zedek Medical Center Thank you, Dr. @Martucci for clarifying.
at Shaare Zedek Medical Center Since this popped back up in my inbox, just a quic...
at UFHealth Shands Jacksonville It was standard policy at our tertiary care center...
at University of Minnesota The key is to always "look for a reason to give th...
Yes, for sure. Disabling is relative and if there is occlusion, it will get worse later on if we don’t open it now with either TPA or TNK when we can’t give them.
It is always good to do CT perfusion in these cases, likely, the occlusion is chronic and there are good collaterals that ha...
Yes, if the stroke is disabling at all, I would give TNK. Whether or not TNK is given, the patient should be monitored very closely and mechanical thrombectomy should be offered if the deficit worsens.
I would give TNK if the patient has NIHSS 1-2 with sxs of Broca’s aphasia, mild rt. NLFD, left ICA occlusion, and CT perfusion scan is not available if the patient is still within the therapeutic window and meets all-inclusive criteria.
Comments
at University of Colorado, Climate & Health Dept I give TNK with almost any symptom (excluding dizz...
Excellent synopsis and I wholeheartedly agree.
Thank you, Dr. @Teitcher. I appreciate your though...
Very helpful.
There are lots of abbreviations being used. I woul...
NIHSS: National Institute of Health Stroke Scale ...
Thank you, Dr. @Martucci for clarifying.
Since this popped back up in my inbox, just a quic...
It was standard policy at our tertiary care center...
The key is to always "look for a reason to give th...