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Tissue plasminogen activator for acute stroke in everyday clinical practice
E J Wirkowski1, M H Gottesman, C Mazer
1Department of Emergency Medicine, Winthrop University Hospital, Mineola, NY, USA.
Summary
Establishing acute ischemic stroke treatment with tissue plasminogen activator (t-PA) is feasible in community hospitals. Patients receiving t-PA showed improved outcomes, including shorter hospital stays and better survival rates.
Area of Science:
- Neurology
- Emergency Medicine
- Cardiovascular Research
Background:
- Acute ischemic stroke requires rapid intervention for optimal patient outcomes.
- Thrombolysis with tissue plasminogen activator (t-PA) is a proven treatment for acute ischemic stroke.
- Implementing acute stroke treatment protocols in non-trial hospitals presents unique challenges.
Purpose of the Study:
- To evaluate the feasibility of establishing an acute stroke treatment program in a community hospital.
- To compare outcomes of acute ischemic stroke patients treated with t-PA versus those not treated within 3 hours of arrival.
- To analyze factors influencing door-to-needle time and treatment eligibility.
Main Methods:
- Prospective analysis of two patient groups within 3 hours of Emergency Department (ED) arrival.
- Comparison of patients treated with t-PA against a matched control group (n=18) with similar NIHSS scores.
- Assessment of neurological deficit severity using the National Institute of Health Stroke Scale (NIHSS).
Main Results:
- Patients receiving t-PA had an average NIHSS score of 14, compared to 13.9 in the non-t-PA group.
- Establishment of an acute stroke treatment algorithm was feasible with CT and neurosurgery services.
- Delays in CT interpretation, lab results, and blood pressure management prolonged door-to-needle time.
Conclusions:
- Acute stroke treatment protocols can be successfully implemented in hospitals without prior trial experience.
- Strict inclusion/exclusion criteria limit the number of eligible t-PA candidates.
- t-PA treatment is associated with shorter length of stay, increased independence, and improved 1-year survival.
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