A 62-year-old woman is brought to the emergency department after her family noticed sudden-onset difficulty speaking and right-sided facial droop that began 45 minutes ago. Her medical history includes hypertension and type 2 diabetes mellitus. She is not taking any anticoagulant medications. Vital signs show a blood pressure of 165/90 mm Hg, heart rate of 82/min, and respiratory rate of 16/min. Neurological examination reveals expressive aphasia, right-sided facial droop, and right upper extremity weakness. The physician prepares to evaluate the patient for intravenous thrombolysis. Which of the following diagnostic tests MUST be obtained and reviewed prior to the administration of intravenous alteplase? (Select all that apply)
- Non-contrast computed tomography of the headAnswer
- Point-of-care blood glucose measurementAnswer
- CCoagulation panel including prothrombin time and international normalized ratio
- D12-lead electrocardiography
- EMagnetic resonance imaging of the brain
Answer
The only tests required prior to administering intravenous alteplase are a non-contrast computed tomography of the head and a point-of-care blood glucose measurement.
The administration of intravenous alteplase (tPA) for acute ischemic stroke is highly time-sensitive. According to current American Heart Association/American Stroke Association (AHA/ASA) guidelines, the only two diagnostic tests that are strictly required prior to initiating tPA in a standard patient are a non-contrast CT scan of the head (to rapidly rule out intracranial hemorrhage, an absolute contraindication) and a point-of-care blood glucose measurement (to rule out hypoglycemia, a common stroke mimic).
Step-by-Step Solution
Key Concept
In patients with suspected acute ischemic stroke who are candidates for thrombolytic therapy, only a non-contrast head CT (to rule out hemorrhage) and a blood glucose assessment (to rule out hypoglycemia) are strictly required before initiating intravenous alteplase.