[Fibrinolytic treatment with tissue plasminogen activator. Outcomes in clinical practice with a multidisciplinary...

Until now treatment of acute cerebral infarction with tissue plasminogen activator (rt-PA) has been applied to a limited extent in large medical centres with acute stroke units. The aim of this study is to determine the safety and effectiveness of this treatment in a centre with no previous experience following a multidisciplinary model.

We conducted a prospective, observation-based study involving patients who were treated with intravenous rt-PA within 3 hours of suffering an acute ischaemic stroke between January 2004 and December 2006. Basal variables, haemorrhagic complications, response to treatment and functional progress were evaluated using the modified Rankin Scale (mRS) at 3 months. Treatment and control were applied following a multidisciplinary protocol implemented by the Intensive Medicine and Neurology services.

In all, 46 patients were treated, their mean age being 67 +/- 12 years (63% males). NIH pre-treatment: 13.6 +/- 4.7; median: 13.5; range: 5-22. Time elapsed between the onset of symptoms and arrival at the hospital was 53 +/- 27 min, and door-to-needle time was 69 +/- 27 min. At 24 hours, 48% of patients had improved their scores on the NIH scale > 4 points. A total of 10 haemorrhagic transformations (21.7%) were observed, none of which were symptomatic. At three months, 54.3% of patients were functionally independent (mRS: 0-2). Mortality rate at 90 days was 13.1%.

Administration of rt-PA to patients with acute ischaemic stroke in health care practice following a multidisciplinary protocol is safe and has a neurological progression that is comparable to clinical trials and studies.