Estimating the number of stroke patients eligible for thrombolytic treatment if delay could be avoided

Although no data are available on the potential number of patients treatable with recombinant tissue plasminogen activator, it is said that up to 20% of all stroke patients should receive this treatment. The actual percentage treated is much lower, mainly due to delays between onset and admission to hospital. The aim of this study was to estimate the potential number of patients eligible for thrombolytic therapy if such delays could be avoided.

We gathered data on the time of onset, presentation and admission of stroke patients. Based on the inclusion and exclusion criteria for thrombolysis derived from the National Institute of Neurological Disorders and Stroke study, we retrospectively estimated the number of patients that would have been eligible for thrombolytic therapy.

A total of 263 consecutive patients were included. Forty-eight patients (18%) had symptoms upon awakening, 28 (11%) reported their symptoms at a routine follow-up visit and 19 (7%) received thrombolytic therapy. All these cases were excluded. If no delay had occurred, an additional 44 patients (17%) could have been offered thrombolytic therapy. This potential loss of treatable patients was due to patient and doctor delay in 39 and 2 patients, respectively, and to other reasons in 3 patients.

Up to 24% of stroke patients are eligible for thrombolytic treatment if delay is avoided. As delays are mainly caused by patients themselves, the results of this study underline the need for campaigns to improve the public's awareness of stroke symptoms as well as the awareness that stroke is an emergency situation.