Despite its efficacy for acute ischemic stroke, tissue plasminogen activator (rt-PA)
is reported as used in less than 5% of patients with stroke. This study assessed the
rate of intravenous rt-PA use in a community hospital and identified factors influencing
rt-PA use. A retrospective chart review revealed a total of 464 patients presenting
to the emergency department with a primary diagnosis of stroke from January 2000 through
June 2002. Records were sorted into 3 groups: those presenting to the emergency department
within 3 hours, 3 to 6 hours, and 6 hours or more of symptom onset. Each record was
reviewed using National Institute of Neurologic Disorders and Stroke thrombolytic
therapy criteria. Primary measures were rate of intravenous rt-PA use and reasons
for not receiving rt-PA. Of the 464 patients with stroke who presented to the emergency
department during the 30-month period, 99 arrived in less than 3 hours, 22 between
3 and 6 hours, and 343 greater than 6 hours. A total of 13 (2.8% of all patients with
stroke or 13% of those presenting within 3 hours) received rt-PA. All patients meeting
criteria received rt-PA. Rapidly improving or minor symptoms and difficult to control
or elevated blood pressure were the most common reasons for not using rt-PA. Of the
patients arriving within the 3-hour window, 14 were excluded by time factors. We conclude
from this study that rt-PA can be effectively used in community hospitals and that
use likely exceeds previously quoted national rates when based on a more appropriate
measure of eligibility criteria as opposed to total presenting patients with stroke.
Key words
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Article info
Publication history
Accepted:
January 7,
2005
Received in revised form:
January 6,
2005
Received:
December 20,
2004
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2005.01.004
Copyright
© 2005 National Stroke Association. Published by Elsevier Inc. All rights reserved.
