Podcast 688: tPA Before Thrombectomy

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">DEVT Trial, a recent non-inferiority study, looked at giving tPA prior to endovascular thrombectomy and was stopped early because there was no benefit shown to giving tPA before this intervention</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Coupled with the SKIP and DIRECT MT trials corroborating these findings, it appears that giving tPA prior to thrombectomy is not indicated</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Whether patients should receive tPA prior to transfer for thrombectomy (i.e. they are in a rural healthcare setting) is still unclear</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Yang P, Treurniet KM, Zhang L, et al. Direct Intra-arterial thrombectomy in order to Revascularize AIS patients with large vessel occlusion Efficiently in Chinese Tertiary hospitals: A Multicenter randomized clinical Trial (DIRECT-MT)-Protocol. Int J Stroke. 2020;15(6):689-698. doi:10.1177/1747493019882837</span></p> <p><span style="font-weight: 400;">Suzuki K, Matsumaru Y, Takeuchi M, et al. Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial [published correction appears in JAMA. 2021 May 4;325(17):1795]. JAMA. 2021;325(3):244-253. doi:10.1001/jama.2020.23522</span></p> <p><span style="font-weight: 400;">Zi W, Qiu Z, Li F, et al. Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke: The DEVT Randomized Clinical Trial. JAMA. 2021;325(3):234-243. doi:10.1001/jama.2020.23523</span></p> <p><em><span style="font-weight: 400;">Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD</sp