Which factors may adversely affect the outcome after a stroke?

Updated: Jan 24, 2018
  • Author: Jeffrey L Saver, MD, FAHA, FAAN; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

See the list below:

  • Identifying the onset time as the time when the symptoms were first observed rather than the last time the patient was known to be well

  • Not following the FDA-approved inclusion/exclusion criteria for thrombolytic therapy with tPA in stroke

  • Failing to discuss with the patient and family the benefits and risks of thrombolytic therapy, including potential for ICH, worsening of neurological deficits, coma, and death

  • Failing to proceed with thrombolytic therapy when it is consistent with best clinical practice and judgment because the patient is unable to authorize treatment and a legally authorized representative is not available

  • Administering anticoagulants or antiplatelet agents during first 24 hours after intravenous tPA

  • Failing to notify the local EMS system of the hospital's readiness to provide thrombolytic therapy, and continuing to accept direct ambulance routing of stroke patients when the facility is not treatment-capable.

  • Failing to offer or administer tPA therapy to patients who are candidates probably the most common cause of tPA-related malpractice litigation. [13]

  • A study looked to determine regional variation in thrombolysis treatment and investigate the extent to which regional variation is accounted for by patient demographics, regional factors, and elements of stroke systems of care. The study reported that there is substantial regional variation in thrombolysis treatment. [39, 40]


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