Thrombolysis Therapy in Specialized and Non-specialized Stroke Units

The benefits of a special stroke care unit (SSCU) over a non-specialized stroke care unit (NSSCU) is well documented in the literature. However, there are concerns that the benefits seen in the SSCU do not consider clinical risk factors that affect thrombolysis therapy.

Retrospective data were collected from a stroke registry between January 1, 2010-June 30, 2016. Univariate analysis determined differences in exclusion criteria between the SSCU and NSSCU, while multivariable binary logistic regression adjusted for confounding variables.

Of the 1,446 acute ischemic stroke patients eligible for rtPA, 34.0% of patients were admitted to the NSSCU, while 58.02% were admitted to the SSCU. For patients excluded from receiving rtPA in the SSCU: age >80 (OR = 1.024-1.037, p = <0.001), altered level of consciousness (OR = 1.551-2.363, p = 0.041), risk of mortality (OR = 1.090-1.166, p = 0.012), previous stroke (OR = 1.638-2.338, p = 0.007) were the exclusion criteria from rtPA. In the NSSCU, age >80 (OR = 1.026-1.046, p = 0.012), history of atrial fibrillation (OR = 2.494-4.629, p = 0.004), diabetes (OR = 2.377-5.576, p = 0.047) and previous stroke (OR = 2.782-4.785, p = <0.001) were associated with exclusion from rtPA.

More patients are likely to be excluded from rtPA in the NSSCU if they present with history of atrial fibrillation, diabetes, and in the SSCU if they present with altered level of consciousness and are at risk of mortality. Improvement in the management of baseline clinical risk factors would improve thrombolysis use for better patient outcomes in specialized and non specialized stroke units.