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Updated: Jul 18, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Why are eligible thrombolysis candidates left untreated?
Nancy K Hills1, S Claiborne Johnston
1Department of Neurology, University of California, San Francisco 94143-0114, USA.
American Journal of Preventive Medicine
|December 21, 2006
Summary
Older age and later hospital arrival are barriers to thrombolytic treatment for acute ischemic stroke patients, even with broader eligibility criteria. This highlights potential biases in stroke care despite proven treatment efficacy.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Thrombolytic therapy, including tissue-type plasminogen activator (tPA), is highly effective for acute ischemic stroke.
- Current utilization of thrombolytics remains low among eligible stroke patients.
- Vague exclusion criteria may obscure underlying biases in treatment administration.
Purpose of the Study:
- To identify barriers to tPA treatment in eligible acute ischemic stroke patients.
- To investigate factors influencing thrombolytic therapy decisions in a real-world setting.
Main Methods:
- Prospective cohort study of ischemic stroke patients arriving within 2.5 hours of symptom onset across 11 hospitals.
- Evaluation of documented contraindications to identify eligible patients for thrombolysis.
- Reclassification of eligibility via record review to assess the impact of comprehensive standards.
Main Results:
- Only 20% of ischemic stroke patients arrived within the 2.5-hour window.
- Initially, 57% of eligible patients received tPA; 44% of these received it within the 3-hour window.
- Older age, later arrival, and non-academic hospital admission predicted nontreatment; these factors persisted after record review.
Conclusions:
- Older age and delayed hospital arrival are significant predictors of undertreatment with thrombolytics.
- Even with refined eligibility criteria, these patient and system factors impede optimal stroke care.
- Addressing these barriers is crucial to improving thrombolytic therapy rates in acute ischemic stroke.
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