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Updated: Jun 3, 2026

Prehospital Thrombolysis: A Manual from Berlin

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

Promoting thrombolysis in acute ischemic stroke.

Maaike Dirks¹, Louis W Niessen, Jeroen D H van Wijngaarden

¹Erasmus MC University Hospital Rotterdam, Department of Neurology, and Institute for Health Policy and Management, Erasmus University Rotterdam, Room H-673, PO Box 2040, 3000 CA Rotterdam, the Netherlands. m.dirks@erasmusmc.nl

|March 12, 2011

Summary

This summary is machine-generated.

An intensive implementation strategy significantly increased thrombolysis rates for acute ischemic stroke patients in real-world settings. Better adherence to contraindications was key to this improvement.

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Published on: November 26, 2013

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Area of Science:

Neurology
Public Health
Implementation Science

Background:

Intravenous recombinant tissue plasminogen activator (rt-PA) is effective for acute ischemic stroke but underutilized.
Limited patient numbers receive timely thrombolysis due to various barriers.

Purpose of the Study:

To evaluate the effectiveness of a multidimensional implementation strategy to increase rt-PA use in acute ischemic stroke.
The PRomoting ACute Thrombolysis in Ischemic StrokE (PRACTISE) trial aimed to improve thrombolysis rates.

Main Methods:

A national multicenter cluster-randomized controlled trial involving 12 hospitals in the Netherlands.
The intervention comprised 5 implementation meetings using the Breakthrough Series model.
Data collected on all admitted stroke patients within 24 hours of symptom onset.

Main Results:

Overall thrombolysis rates were 13.1% in intervention centers vs. 12.2% in control centers (adjusted OR, 1.25).
For ischemic stroke patients admitted within 4 hours, thrombolysis rates were 44.5% (intervention) vs. 39.3% (control) (adjusted OR, 1.58).

Conclusions:

Intensive implementation strategies can enhance thrombolysis rates for acute stroke in clinical practice.
Improved application of thrombolysis contraindications was identified as a critical factor for treatment rate improvement.