Title: Errors and Safety Considerations with Alteplase for Acute Ischemic Stroke<br/>Author: Ashley Martinelli<br/><a href='mailto:1912'>[Click to email author]</a><hr/><ul>
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                Retrospective review of 676 patients who received alteplase for acute ischemic stroke
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                                34% at a Comprehensive Stroke Center (CSC)</li>
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                                66% at regional hospitals
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                                                12.9% acute stroke ready facility</li>
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                                                12.3% primary stroke center</li>
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                                                74.8% undesignated facility</li>
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                No differences in patient baseline characteristics who received alteplase but thrombectomy was more common at CSC (62 years old, 50% female, 17% thrombectomy, NIHSS 9, weight 85kg, mRS 3)</li>
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                <strong>19.8% of patients experienced an error with alteplase administration</strong>
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                                10 (1.5%) at CSC</li>
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                                123 (18.2%) at regional hospitals
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                                                15% at acute stroke ready facility</li>
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                                                69% at undesignated facility</li>
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                Most common errors listed below:
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                                1. Over-dosing alteplase</li>
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                                2. Under-dosing alteplase</li>
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                                3. Administration with contraindications</li>
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                Most common contributing factors:
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                                Incorrect weight, calculation errors, programming the pump incorrectly</li>
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                8.3% of the entire study population experienced hemorrhagic conversion and this incidence was higher in patients with an alteplase error</li>
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        <strong>Conclusion: Alteplase is a high risk medication.  Safeguards should be developed and enacted in all centers regardless of their stroke certification.  CSCs should closely examine the dose and pump settings for accuracy during the transfer process to mitigate harm.</strong></p>
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<fieldset><legend>References</legend>

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        Dancsecs KA, Nestor M, Bailey A, et al. Identifying errors and safety considerations in patients undergoing thrombolysis for acute ischemic stroke. Am J Emerg Med. 2021;47:90-94.</p>
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        PMID: 33794475</p>
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