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    SEDAN Score for Post-tPA Hemorrhage

    Predicts risk of Symptomatic Intracerebral Hemorrhage (sICH) after tPA.
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    INSTRUCTIONS

    Applies to patients receiving tPA within 4.5 hours; does not apply to patients receiving endovascular treatment.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Providing actual estimates of risk of tPA to patients and their family members.
    • Weighing risk of benefit and risk of harm in minor or severe strokes.
    • The SEDAN Score predicts risk of post-tPA hemorrhage.
    • tPA hemorrhage risk varies greatly, so its developers wanted to predict low- and high-risk patients.
    • The endpoint, “Symptomatic Intracerebral Hemorrhage” varies greatly from trial to trial depending on definition, making it difficult to compare outcomes.
    • The HAT Score also predicts risk of sICH with fewer variables.
    • The THRIVE Score predicts chance of good outcome after stroke (even without tPA) and does not require imaging variables.

    Points to Consider

    • Patients in this score did not receive endovascular therapy.
    • sICH increases mortality dramatically.
    • tPA risks and benefits should be very clearly discussed and documented with patients and family members.

    With rates of sICH varying widely, the SEDAN Score can help predict which patients will be at low or high risk to go on to have sICH, which increases mortality dramatically.

    <145 mg/dL (8.1 mmol/L)
    0
    145-216 mg/dL (8.1–12.0 mmol/L)
    +1
    >216 mg/dL (12.0 mmol/L)
    +2
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1

    Result:

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    Advice

    • Consider tPA contraindications closely, as institutions may have slightly different definitions of contraindications (absolute and relative).
    • tPA for stroke should only be given in conjunction with Neurology consultation and after extensive discussion with the patient and family about risk and benefit.
    • Patients receiving tPA should be monitored in an ICU setting.
    • Even in low-risk patients, patients with changing neurologic exams or mental status should receive emergent re-imaging to assess for sICH.
    • Consider other bleeding sites (GI, GU, for example) in post-tPA patients and exercise caution with even minimally invasive procedures such as venipuncture or foley catheter placement.
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    About the Creator
    Dr. Daniel Strbian
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