[Intravenous thrombolysis managed by a stroke team. Its feasibility]

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• Ischemic stroke is a major cause of adult death and disability.
• Intravenous thrombolysis (IVT) is effective but underutilized in Argentina, particularly outside specialized Stroke Units.
• Limited access to IVT hinders optimal patient outcomes in resource-constrained settings.

Purpose of the Study:

• To assess the feasibility of implementing IVT for ischemic stroke patients in a general emergency room setting.
• To evaluate utilization, effectiveness, and safety indicators of IVT administered by a multidisciplinary team.
• To determine if IVT can be safely and effectively provided outside of traditional Stroke Units.

Main Methods:

• Retrospective observational study of 1215 ischemic stroke patients (September 2017 - July 2024).
• Comparison of clinical characteristics, door-to-needle times, neurological outcomes (NIHSS score improvement), and complications (symptomatic intracranial hemorrhage, mortality) between IVT-treated and untreated patients.
• Analysis focused on patients treated in a general emergency room by a multidisciplinary team.

Main Results:

• 12% (n=143) of patients received IVT, with a median door-to-needle time of 75 minutes (38% treated <60 minutes).
• IVT significantly improved neurological outcomes (43% vs. 14%; OR 5.5; p<0.001) but increased symptomatic intracranial hemorrhage risk (8.4% vs. 0.2%; OR 21.8; p<0.001).
• In-hospital mortality showed no significant difference between groups (14% vs. 9.0%; OR 0.8; p=0.6).

Conclusions:

• Implementing IVT in general emergency rooms by specialized teams is feasible and achieves quality indicators comparable to specialized centers.
• This model can enhance access to effective stroke treatments in settings with limited resources.
• The study demonstrates a viable organizational strategy for improving ischemic stroke care.