Lack of experience of intravenous thrombolysis for acute ischaemic stroke does not influence the proportion of patients treated

Abstract

Objectives: To determine the eligibility of patients with ischaemic stroke admitted to the 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland, for intravenous thrombolysis; to identify the major exclusions and assess whether organisational changes in the in-hospital stroke pathway and informative campaign in the local community and medical services can increase the number of patients treated; and to establish whether lack of previous experience with thrombolytic treatment or trials is predictive of the low proportion of patients treated. Methods: A survey of the database of patients with stroke admitted during the first 30 months after the introduction of intravenous thrombolysis for acute ischaemic stroke was conducted to search for all eligible patients. This included patients admitted within 2 h of symptom onset (assuming a 1 h door-to-needle time), age ,80 years, National Institute of Health Stroke Scale (NIHSS) Score of 5-22, seizures at onset, platelet count .100 000/ml, glycaemia 50-400 mg/dl and international normalised ratio (INR) ,1.6. The number of eligible patients was compared with the number actually treated. Results: 745 patients with acute ischaemic stroke were admitted during the study period. 18.4% were admitted within 2 h of symptom onset, 71% were aged ,80 years, 55.4% had an NIHSS score between 5 and 22, 96.1% had INR ,1.6, 98.9% had a platelet count .100 000/ml, 99.4% had blood glucose concentrations of 50-400 mg/dl and 97.4% had no seizures at onset. After adjusting for all inclusion criteria, 7.1% of the patients were found to be potentially eligible and 8.7% were actually treated (p = 0.25). Of the 65 treated patients, 63.1% were independent after 3 months, 16.9% died and none had a symptomatic intracranial haemorrhage. Conclusions: The proportion of patients with ischaemic stroke treated with intravenous thrombolysis in a previously inexperienced centre was not lower than in other centres and in countries where this treatment has been provided for a longer period of time. The number of patients treated was higher than that estimated mainly owing to organisational changes introduced in our centre, allowing treatment of those admitted between 2 and 3 h after symptom onset.

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

“…Rates in hospitals with an in-hospital restricted SC were significantly better than those in hospitals without SC (OR 2.75, 95% CI: 1.92-3.97, p b 0.001). The statistical analyses showed a heterogeneous study in each group [18,22,25]. The analyses without these three studies led to the same conclusions (Supplementary file 4).…”

“…2), the rates were significantly higher in the hospitals using a SC with prenotification (mean thrombolysis rate=54.7% among n=609) [6,22,26,27], including Tenon hospital, compared with those without SC (mean thrombolysis rate=18.2% among n=297) [6,14,18] (OR 5.43, 95% CI: 3.84-7.73, p b 0.001) and even compared with those with an inhospital restricted SC (mean thrombolysis rate =37.9% among n =477) [10,16,25,28] (OR 1.97, 95%CI: 1.53-2.54, p b 0.001). Rates in hospitals with an in-hospital restricted SC were significantly better than those in hospitals without SC (OR 2.75, 95% CI: 1.92-3.97, p b 0.001).…”

“…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].…”

Outcomes of Intravenous Thrombolytic Therapy for Acute Ischemic Stroke With an Integrated Acute Stroke Referral Network: Initial Experience of a Community-Based Hospital in a Developing Country

“…[12][13][14][15][16] In the present study, 21% of the AIS patients admitted to our stroke unit received IV thrombolytic treatment. This is a relatively high IV thrombolytic treatment rate compared with previous reports.…”