Practice Patterns and Barriers for Intravenous Thrombolysis: A Survey of Neurologists in Saudi Arabia
Table 2
Number and percentage of neurologists who would administer intravenous tissue plasminogen activator (IV-tPA) in the presence of each exclusion criterion.
Criteria for the question “Which of the potential IV-tPA exclusion criteria (based on 2015 AHA/ASA scientific statement or tPA package insert) WOULD NOT necessarily prevent you from administering IV-tPA to a patient with a perceived disabling stroke (provided other inclusion/exclusion criteria are met)?” Multiple answers allowed
Number of responses (%), total
None. I do not “bend” any of the guideline exclusion criteria
8 (9.9)
Minor stroke (NIHSS < 5)
40 (49.4)
Rapidly improving stroke symptoms
24 (29.6)
Ischemic stroke within 3 months
25 (30.9)
Significant head trauma within 3 months
9 (11.1)
Seizure at onset
37 (45.7)
Intracranial or intraspinal surgery in the prior 3 months
11 (13.6)
Blood pressure > 185/110 mm Hg despite appropriate treatment efforts to control it
11 (13.6)
Current use of anticoagulant with INR > 1.7 or PT > 15
10 (12.4)
Receiving heparin within 48 hours with aPTT value > 40 (abnormal)
6 (7.4)
Receiving direct thrombin inhibitor or factor Xa inhibitor within 48 hours with normal coagulation profile (PT, PTT, INR, platelet count, clotting time, thrombin time, factor Xa activity assays)
12 (14.8)
Receiving direct thrombin inhibitor or factor Xa inhibitor within 48 hours with unknown coagulation profile (PT, PTT, INR, platelet count, clotting time, thrombin time, factor Xa activity assays)
6 (7.4)
Receiving direct thrombin inhibitor or factor Xa inhibitor within 48 hours with abnormal coagulation profile (PT, PTT, INR, platelet count, clotting time, thrombin time, factor Xa activity assays)
6 (7.4)
Received therapeutic LMWH within 24 hours
4 (4.9)
Major surgery within 14 days
15 (18.5)
Major extracranial trauma within 14 days
12 (14.8)
Active internal bleeding
9 (11.1)
Previous ICH
15 (18.5)
Symptoms suggestive of subarachnoid hemorrhage (SAH)
6 (7.4)
Intracranial unruptured unsecured aneurysm
11 (13.6)
Intracranial remotely ruptured, secured aneurysm
13 (16.1)
Platelet count < 100,000
10 (12.4)
CT showing hypodensity > 1/3 of the cerebral hemisphere
12 (14.8)
ST elevated MI in previous 3 months
11 (13.6)
NSTEMI in previous 3 months
17 (21.0)
Gastrointestinal hemorrhage in previous 21 days
13 (16.1)
Genitourinary hemorrhage in previous 21 days
11 (13.6)
Glucose < 50 mg/dl (deficits persist after glucose correction)
12 (14.8)
Known brain tumor
6 (7.4)
Intracranial AVM (arteriovenous malformation)
9 (11.1)
Arterial puncture at a noncompressible site within 7 days
