Abstract TMP64: Development of a Thrombolysis Protocol for Acute Ischemic Stroke Patients Treated with Dabigatran.
Bibliographic record
Abstract
Introduction: Acute ischemic stroke thrombolysis in patients taking dabigatran is controversial, due to a presumed increased risk of symptomatic hemorrhagic transformation. The lack of a standardized test of anticoagulant activity or defined coagulation markers to select patients safely, makes thrombolysis in dabigatran treated patients challenging. Using data from our hematopathology laboratory, we aimed to develop a protocol for selection of thrombolysis candidates amongst acute ischemic stroke patients taking dabigatran. Method: A thrombin time (TT)-dabigatran concentration curve was calculated using dabigatran plasma calibrators (Aniara, West Chester, OH). The effect of dabigatran on activated partial thromboplastin time (aPTT) was also calculated. A table of dabigatran concentration, TT and aPTT was produced and distributed to all stroke team members. A protocol was developed, in which a dabigatran concentration of <47 ng/ml (corresponding to a TT <19.7 s and aPTT <37 s) was selected as the upper limit for safe thrombolysis. In tertiary stroke centres, a TT and aPTT were both ordered, while in peripheral telestroke centres, the aPTT alone was used to determine dabigatran activity. Results: In the 4 months since development of the protocol, eight potential thrombolysis candidates taking dabigatran were assessed with CT at a median (IQR) time of 192 (143) minutes. The median NIHSS was 16 (12). Based on TT/aPTT, only 2 patients were ineligible for thrombolysis (dabigatran concentrations >118 ng/ml). Another three patients were not treated due to minor/resolving symptoms and a fourth due to intracerebral hemorrhage. Two patients were treated with intravenous tPA (0.9 mg/kg). A repeat CT head at 24 hours revealed no hemorrhagic transformation in one patient and asymptomatic petechial hemorrhagic transformation (European Cooperative Acute Stroke Study Grade Hemorrhagic Infarction Type 1) in the other. Conclusion: It is possible to safely administer intravenous tPA in dabigatran treated patients, provided a reliable method of measuring anticoagulant activity is available. Although, TT and aPTT dabigatran concentrations do vary between laboratories, individual protocols can and should be developed at acute stroke treatment centres.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".