Lack of t-PA use for acute ischemic stroke in a community hospital: High incidence of exclusion criteria

Engelstein, Elly; Margulies, Jeffrey; Jeret, Joseph S.

doi:10.1016/s0735-6757(00)90116-5

Cited by 41 publications

(26 citation statements)

References 17 publications

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“…86 Other reports also show that only approximately 1% to 2% of patients with ischemic stroke are being treated with alteplase. 81,87,88 The mean annual number of patients treated with alteplase per hospital in the United States is only 3. This limited experience of emergency physicians and nurses with stroke fibrinolytic therapy protocols appears to be an important contributor to the occurrence of errors.…”

Section: Michaels Et Al Medication Errors In Acute CV and Stroke Patimentioning

confidence: 99%

Medication Errors in Acute Cardiovascular and Stroke Patients

Michaels¹,

Spinler²,

Leeper³

et al. 2010

Circulation

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Section: Michaels Et Al Medication Errors In Acute CV and Stroke Patimentioning

confidence: 99%

Medication Errors in Acute Cardiovascular and Stroke Patients

Michaels¹,

Spinler²,

Leeper³

et al. 2010

Circulation

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“…It is estimated that only 2-5% of all patients presenting with ischemic stroke receive intravenous thrombolysis. The primary reason for exclusion is the narrow time window (<3 hr) from the onset of symptoms to treatment [5][6][7][8]. Though efforts are underway to educate the public about the warning signs of stroke and the need to seek care rapidly, the estimated ceiling of eligible patients who could benefit from intravenous thrombolysis remains 1 in 5 of all ischemic stroke patients [9].…”

Section: Introductionmentioning

confidence: 99%

Acute stroke intervention by interventional cardiologists

DeVries

White

Collins

et al. 2009

Cathet Cardio Intervent

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Objectives: To report the technical success and clinical outcomes of catheter-based therapy (CBT) for acute ischemic stroke in patients ineligible for intravenous thrombolysis. Background: Acute ischemic stroke is common but undertreated. CBT for acute ischemic stroke is a therapeutic option in selected patients who are not candidates for intravenous thrombolysis. Methods: Consecutive stroke patients who were ineligible for intravenous thrombolysis and underwent CBT were identified by retrospective chart review. Demographic information, National Institutes of Health Stroke Scale (NIHSS), procedural characteristics, and clinical outcomes during hospitalization and at 90 days follow up were collected. Experienced interventional cardiologists with the consultative support of stroke neurologists were on call for acute strokes. Results: A total of 33 acute ischemic stroke patients underwent emergency cerebral angiography, with 26 patients undergoing CBT. Successful ' 'culprit' ' artery recanalization was achieved in 23 (88%) of the 26 patients. In-hospital adverse events occurred in 4 (15%) patients, with intracerebral hemorrhage (ICH) (12%) representing the most common adverse event. The baseline NIHSS for patients who underwent intervention was 16.5 6 9.9 (median 16) and improved significantly to 9.9 6 8.7 (median 9) (P < 0.001) at hospital discharge. A modified Rankin score of two or less (indicating mild disability) was achieved in half (n 5 13) of the CBT treated patients. All cause mortality at 90 days was 8% (2/26). Conclusions: In selected patients, CBT provided by qualified interventional cardiologists supported by stroke neurologists, offers a safe and effective option for patients with acute stroke who are not eligible for intravenous thrombolysis. '

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“…1 Multiple studies have confirmed the benefits of rt-PA when appropriate patients are selected, 2-7 yet very few ischemic stroke patients receive rt-PA. Although single centers might report rates as high as 20%, 4,8 national and population-based estimates of rt-PA use range from 1% to 4% of all ischemic stroke patients. 9 -11 Determining a "true" national rate of rt-PA use is quite challenging for several reasons.…”

mentioning

confidence: 99%

National US Estimates of Recombinant Tissue Plasminogen Activator Use

Kleindorfer

Lindsell

Brass

et al. 2008

Stroke

260

187

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Background and Purpose-Current US estimates of recombinant tissue plasminogen activator (rt-PA) use have been based either on extrapolation of regional studies or on administrative database estimates, both of which may have inherent biases. We sought to compare the utilization of rt-PA in acute ischemic stroke in the MEDPAR database to another national hospital database with drug utilization information. Methods-Cases

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Lack of t-PA use for acute ischemic stroke in a community hospital: High incidence of exclusion criteria

Cited by 41 publications

References 17 publications

Medication Errors in Acute Cardiovascular and Stroke Patients

Medication Errors in Acute Cardiovascular and Stroke Patients

Acute stroke intervention by interventional cardiologists

National US Estimates of Recombinant Tissue Plasminogen Activator Use

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