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Thrombolysis for acute stroke in routine clinical practice
Dawn M Bravata1, Nancy Kim, John Concato
1Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8025, USA. dawn.bravata@yale.edu
Archives of Internal Medicine
|September 17, 2002
Summary
Thrombolytic therapy for acute stroke in routine practice often involves protocol deviations, leading to higher mortality and hemorrhage rates compared to clinical trials. Adhering to protocols is crucial for improving patient outcomes in real-world stroke treatment.
Area of Science:
- Neurology
- Clinical Practice
- Public Health
Background:
- Thrombolytic therapy for acute stroke is effective in controlled settings.
- Outcomes in routine clinical practice remain under-investigated.
Purpose of the Study:
- Compare real-world thrombolysis outcomes with a clinical trial cohort (NINDS).
- Examine the impact of protocol deviations on adverse events.
Main Methods:
- Retrospective cohort study of 63 patients receiving thrombolysis for acute stroke in Connecticut (1996-1998).
- Comparison with the NINDS rt-PA Study cohort.
Main Results:
- 67% of patients had major protocol deviations; 97% had minor or major deviations.
- Higher in-hospital mortality (25% vs 13%) and hemorrhage rates (13% vs 2%) in the Connecticut cohort.
- Major deviations correlated with increased mortality and hemorrhage.
Conclusions:
- Protocol deviations are common in routine stroke thrombolysis.
- Deviations significantly increase mortality and hemorrhage risk in stroke patients.