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Eligibility for recombinant tissue plasminogen activator in acute ischemic stroke: a population-based study
Dawn Kleindorfer1, Brett Kissela, Alex Schneider
1Department of Neurology, University of Cincinnati College of Medicine, the Neuroscience Institute, OH 45267, USA. dawn.kleindorfer@uc.edu
Stroke
|January 24, 2004
Summary
Few acute ischemic stroke patients received recombinant tissue plasminogen activator (rtPA). In 1993-1994, only 8% of stroke patients met rtPA eligibility criteria, including time to treatment, highlighting low rtPA utilization rates.
Area of Science:
- Neurology
- Public Health
- Emergency Medicine
Background:
- Recombinant tissue plasminogen activator (rtPA) is an underutilized treatment for acute ischemic stroke.
- Population-based data on rtPA eligibility are scarce.
Purpose of the Study:
- To determine the eligibility of ischemic stroke patients for rtPA treatment in a unique biracial population.
- To analyze factors influencing rtPA eligibility, including time to treatment and clinical criteria.
Main Methods:
- Identified all ischemic strokes presenting to emergency departments (EDs) within a 1.3 million population.
- Assessed rtPA eligibility based on National Institute of Neurological Disorders and Stroke (NINDS) rtPA trial exclusion criteria.
Main Results:
- Of 2308 ischemic strokes, 1849 presented to an ED; only 22% arrived within 3 hours of symptom onset.
- Among those arriving within 3 hours, 51% were ineligible for rtPA due to stroke severity, medical history, or blood tests.
Conclusions:
- In 1993-1994, only 8% of all ischemic stroke patients met rtPA eligibility criteria, including the 3-hour window.
- Even without time constraints, only 29% of all ischemic strokes would have been eligible for rtPA, indicating broader eligibility issues.