Eligibility for Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke

Abstract

Background: The eligibility for recombinant tissue plasminogen activator (rtPA) is rare. We analyze the reasons for exclusion from rtPA among patients who were admitted to our hospital within 3 h. Methods: A strict protocol for hyperacute stroke was set in a university teaching hospital. Consecutive patients activating the protocol from June 2004 to October 2005 were prospectively registered and entered into a computerized database. The patients were excluded from rtPA according to the modified exclusion criteria from the National Institute of Neurological Disorders and Stroke rtPA trial. Results: Of the 182 patients activating the protocol, only 11 (6.04%) received intravenous rtPA and 4 (2.2%) IA thrombolysis. Patients were excluded for multiple reasons, and the main reasons for exclusion were minor or improving stroke (46.15%), hypertension (35.16%), insufficient time to complete studies or onset beyond 3 h after reconfirmation (24.17%) and intracranial hemorrhage (15.93%). Of 167 excluded patients, 72 (43.11%) were excluded by a single criterion, 53 (31.73%) by 2 criteria and 29 (17.36%) by 3 criteria. The mean time from hospital arrival to presentation to a neurologist was 9.24 ± 15.11 min (n = 164, median = 8.00, mode = 10, range = 0–65). The mean time from hospital arrival to computed tomography (CT) was 21.67 ± 23.95 min (n = 167, median = 20.00, mode = 10, range = 4–68). Conclusion: An intrahospital stroke code was implemented to minimize intrahospital delay. However, only 11 patients received intravenous rtPA and 4 IA thrombolysis at our hospital from June 2004 to October 2005. The result brings into question the neurologist’s conservative interpretation of the criteria and the necessity to clearly define some criteria. Furthermore an intrahospital stroke code should also be implemented for inpatients to maximize the eligibility for rtPA.

Outcome of Acute Ischemic Stroke in Very Elderly Patients: Is Intravenous Thrombolysis Beneficial?

“…Therefore, controversy exists regarding the risk and benefit of tPA treatment for patients in this age group. In the European Union, tPA was approved in 2002 with the age limitation of 18–80 years, which was also adopted in Taiwan’s License and older age has become a major reason for tPA exclusion in Taiwan [27]. Nevertheless, recent studies support stroke thrombolysis in the elderly population and several countries do not impose age limitations.…”

Thrombolysis rate and impact of a stroke code: A French hospital experience and a systematic review

“…We excluded 22 studies with a study period before 2000, 2 retrospective and 2 redundant studies. The 23 remaining studies extended from January 2000 to May 2008 [1,2,6,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] (Table 1). Seven studies were conducted in North America [1,6,[12][13][14]21,22], 12 in Europe [2,11,[15][16][17][18][19][25][26][27][28][29], 3 in Asia [10,20,23] and 1 in Australia [24].…”

“…Eight other studies used a SC restricted to the hospital system [10,16,20,21,[23][24][25]28] and one implemented a SC during the study period [6]. Two did not have any SC [14,18].…”

Improving Outcome after Stroke: Overcoming the Translational Roadblock

“…Yet, thrombolysis carries risks, particularly of intracerebral haemorrhage [21]. At present, recombinant tissue plasminogen activator (rtPA) is the only approved agent.…”