my personal edition > stroke > news


  E-Mail this DGReview to a colleague

DGReview

Few Stroke Patients Seek Help In Time To Receive Tissue Plasminogen Activator

A minority of patients who experience an ischaemic stroke arrive at an emergency department in time to receive intravenous (IV) tissue plasminogen activator (tPA), which could dissolve blood clots and restore blood flow, research in the United States indicates.

Researchers, led by Irene Katzan, MD, MS, from the Cleveland Clinic Foundation, Cleveland, Ohio, report that only 15% of patients who experienced an ischaemic stroke arrived at 1 of 9 foundation hospitals within the 3-hour time window needed for IV tPA use. Of these patients, only 6.9% were found to be eligible to receive IV thrombolysis.

"The most common community reasons for exclusion from IV tPA use are late emergency department arrival and minor neurological deficits," the researchers state.

Many community doctors seem to apply a variety of relative contraindications, including pre-stroke functional status and age, and that in a "sizable" number of patients the reason for lack of treatment was not apparent from patient medical records, they add.

Thrombolysis with IV tPA was approved by the US Food and Drug Administration in 1995, but estimates suggest it is only used in approximately 2% of patients who have had a stroke.

Patients included in the 1-year study represented 43% of all stroke admissions in the Cleveland area between June 1999 and June 2000. Of the 1,923 patients in the study, 15% arrived at the hospital within 3 hours. Mean age of these patients was 72.9 years, 49.3% were women and 20.3% were African American. The most commonly associated medical problems were hypertension (72.2%) and coronary artery disease (38.3%).

Of patients seen within 3 hours, 19.4% received IV thrombolysis, including 47 patients who received IV tPA and 9 who received intra-arterial tPA.

A total of 56 of 129 eligible patients without documented contraindications received IV tPA, for a rate of use among eligible patients of 43.4%. This did not differ significantly by race or sex.

Absolute contraindications were documented in 98 eligible patients. Most frequent were minor symptoms, including National Institutes of Health Stroke Scale scores of less than 4 in 77% of the patients and rapidly resolving symptoms in 44%.

The researchers say attention to treatment barriers should increase IV tPA use among acute stroke patients.






Arch Neurol 2004;61:346-350.

E-Mail this DGReview to a colleague

To print, use this version