Introduction: The existence of contraindications for intravenous thrombolysis (IVT) has been proposed as criterion for direct transfer to thrombectomy-capable centers (EVT-C) in the prehospital setting. Our aim was to evaluate whether this criterion would improve current patient selection by Madrid-DIRECT prehospital scale. Methods: We carried out a prospective observational study of code stroke patients evaluated by emergency services SUMMA-112 using the Madrid-DIRECT scale from March 2017 to June 2017. We collected reported contraindications for IVT, clinical examination, patient destination according to Madrid-DIRECT score and reperfusion treatments. We analysed the association of IVT contraindications with final diagnosis and treatments. Results: We included 326 patients (mean age 69±15.8 years). 139 (42.6%) patients had a known contraindication for IVT (90 more than 4.5 hours or unknown time from symptom onset, 48 anticoagulation, 17 other contraindications). One hundred patients (30.7%) scored positive in the Madrid-DIRECT scale, and 226 patients (69.3%) scored negative. EVT was performed in 68 (20.9%) patients, 53 (53%) of the Madrid-DIRECT positive and 15 (6.6%) of the Madrid-DIRECT negative. Surprisingly, we found non-significantly lower EVT rates among patients with IVT contraindications: 47.7% vs 57.1% (p = .35) for Madrid-DIRECT positive patients, and 4.2% vs 8.4% (p = .21) for Madrid-DIRECT negative patients. Anticoagulated patients presented with higher proportions of hemorrhagic stroke (25% vs 11.9%) and fewer stroke mimics (4.2% vs 22.7%), p = .02. Conclusions: Existence of IVT contraindications does not increase EVT likelihood over existing Madrid-DIRECT prehospital scale, as it depends on the presence of a treatable large vessel occlusion.
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