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Open label tissue plasminogen activator for stroke: the Oregon experience
Background:
Tissue plasminogen activator (t-PA) is the first effective treatment for stroke. This study sought to explore the outcome of patients treated with t-PA in the community after approval of its use in the treatment of stroke in June, 1996.
Methods:
All patients with acute stroke within the 6-hospital Oregon Stroke Center network were screened for potential t-PA treatment. Baseline and 24-hour outcome assessments were performed with the use of the National Institutes of Health Stroke Scale (NIHSS) and computed tomography (CT); 3-month outcome was evaluated by using the Modified Rankin scale.
Results:
Thirty-three patients who met the criteria for t-PA therapy were treated within 3 hours of symptom onset. All but 2 strokes were in the anterior circulation; 48.5% were cardioembolic. The NIHSS scores at 24 hours after administration of t-PA (mean, 14.7) showed modest gains from baseline NIHSS scores (mean, 16.6). Twelve patients (36%) had minimal or no deficits at 3 months. Three patients (9%), all of whom had baseline NIHSS scores of 20 or more, had symptomatic intracranial hemorrhages, 2 of which were fatal (6%).
Conclusion:
This study shows the feasibility of treating acute stroke with t-PA in the community. The percentage of fully recovered patients at 3 months mirrored those in the National Institute of Neurologic Disorders and Stroke (NINDS) trial.
Insights
Community treatment with tissue plasminogen activator (t-PA) for acute stroke is feasible. Outcomes in patients receiving t-PA mirrored those from the NINDS trial, demonstrating its effectiveness in real-world settings.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Emergency Medicine
Background:
- Tissue plasminogen activator (t-PA) is a primary treatment for acute stroke.
- This study evaluated t-PA treatment outcomes in a community setting following its 1996 approval.
- The Oregon Stroke Center network facilitated the study.
Purpose of the Study:
- To assess the feasibility and outcomes of community-based t-PA treatment for acute stroke.
- To compare community treatment results with established clinical trial data.
Main Methods:
- Screened patients within a 6-hospital network for t-PA eligibility.
- Assessed outcomes using the National Institutes of Health Stroke Scale (NIHSS) at baseline and 24 hours.
- Evaluated 3-month outcomes with the Modified Rankin scale.
Main Results:
- 33 patients treated within 3 hours of symptom onset; most had anterior circulation or cardioembolic strokes.
- NIHSS scores showed modest improvement at 24 hours post-t-PA (mean 14.7 from 16.6).
- 36% achieved minimal/no deficits at 3 months; 9% experienced symptomatic intracranial hemorrhage, with a 6% fatality rate.
Conclusions:
- Community-based t-PA treatment for acute stroke is feasible.
- Achieved recovery rates align with findings from the National Institute of Neurologic Disorders and Stroke (NINDS) trial.
- Highlights the successful integration of t-PA therapy into community stroke care.
