This is so simple, its time to come up with other hyperacute options.
http://www.neurology.org/content/early/2012/12/05/WNL.0b013e31827b1b7c.short
The appropriate use of IV tissue plasminogen activator (tPA) for
patients with acute ischemic stroke remains an area of active
discussion among health care professionals. Since
its approval in the United States by the Food and Drug Administration in
1996, the medical community has continued to review
and discuss the risks vs benefits of this important therapy. Two recent
publications1,2 and accompanying editorials have refocused attention on the vexing issue of using IV tPA in patients taking warfarin. The
Xian et al.1 study found a 1.1% absolute
increase in the risk of intracranial hemorrhage (ICH) with warfarin use
(5.7% vs 4.6%), but this
difference was no longer present once the analysis
was adjusted for various risk factors. The Ruecker et al.2 study reported a 20% risk of ICH, but the difference was barely significant (p = 0.044) once proper adjustments were made. It is important to consider that successful recanalization or reperfusion of
the stroke is likely to have precipitated a hemorrhage in some of these cases.3 Therefore the reported measure (cerebral hemorrhage) might actually be consequent (in part) to the therapeutic intervention,
and not solely related to therapy with warfarin.
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