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

Ischemic stroke is one of the leading causes of death and disability in adults. Although intravenous thrombolysis (IVT) has been shown to be a cost-effective intervention, its use in Argentina remains limited, especially outside of Stroke Units. The objective was to evaluate the feasibility of implementing IVT in patients with ischemic stroke treated by a multidisciplinary team in the general emergency room of a public hospital in Argentina, through the analysis of utilization, effectiveness, and safety indicators.

A retrospective observational study based on a cohort of 1215 patients with ischemic stroke admitted between September 2017 and July 2024. Clinical characteristics, door-to-needle time, neurological outcomes (=4-point improvement on the NIHSS score), and complications, including symptomatic intracranial hemorrhage (SIH) and in-hospital mortality, were compared between patients treated and untreated with IVT.

Twelve percent of patients (n=143) received IVT. The median door-to-needle time was 75 minutes; 38% were treated in less than 60 minutes. SHI occurred in 8.4% of treated patients versus 0.2% of untreated patients (OR 21.8; 95% CI: 5.4-87.1; p<0.001). Treatment was associated with significant neurological improvement (43% vs. 14%; OR 5.5; 95% CI: 3.7-8.2; p<0.001). No significant differences were observed in in-hospital mortality (14% vs. 9.0%; OR 0.8; 95% CI: 0.4-1.6; p=0.6).

Implementing IVT outside of a Stroke Unit, by a specialized team in a general ward, is feasible with acceptable quality indicators compared to those reported in more complex centers. This organizational model could contribute to improving access to effective treatments in resource-limited settings.