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Timing of Tissue Plasminogen Activator for Acute Ischemic Stroke: Outcomes-Based Recommendations for Practice

Hanselman, Carol J.

Journal of Neuroscience Nursing: December 2014 - Volume 46 - Issue 6 - p 314–320
doi: 10.1097/JNN.0000000000000091

ABSTRACT: Acute ischemic stroke (AIS) is a major cause of death and disability in the United States. Tissue plasminogen activator (t-PA) is an intravenously administered therapy that can prevent death and disability for patients presenting within early onset of AIS. There has been a debate around the exact time parameters for administration, because very few patients present to the hospital within the initial 0- to 3-hour window of time. Not all of the current national guidelines for timing of AIS in the United States are in agreement with regards to this issue. To the nurse caring for patients with neurologic illnesses, this topic is of utmost importance. Nurse are not only involved in determining the time of stroke symptom onset, but nurses also hold responsibility for a working knowledge of the latest eligibility and exclusion criteria for t-PA administration. This article examines the central body of research related to the timing of t-PA and makes recommendations for eligible candidates based on this literature.

Questions or comments about this article may be directed to Carol J. Hanselman, BSN BSE MSN ACNP-BC RN, at She is a Nurse Practitioner, Emergency Department, Temecula Valley Hospital, Temecula, CA.

The author declares no conflict of interest.

© 2014 American Association of Neuroscience Nurses