Community implementation of intravenous thrombolysis for acute ischemic stroke in the 3- to 4.5-hour window

• Published in: The American journal of emergency medicine 2013-12, Vol.31 (12), p.1707-1709
• Main Authors: Montaño, Arturo, MD, Staff, Ilene, McCullough, Louise D., MD, Fortunato, Gil
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Aged; Aged, 80 and over; Brain Ischemia - drug therapy; Diabetes; Emergency; Emergency medical care; Female; Fibrinolytic Agents - therapeutic use; Heart attacks; Hemorrhage; Hospital Mortality; Hospitalization; Humans; Hypertension; Intracranial Hemorrhages - chemically induced; Male; Middle Aged; Mortality; Multivariate analysis; Retrospective Studies; Stroke; Stroke - drug therapy; Studies; Thrombolytic Therapy - methods; Time-to-Treatment - statistics & numerical data; Tissue Plasminogen Activator - therapeutic use; Tomography; Treatment Outcome; United States
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2013.08.032

Abstract Background Intravenous (IV) tissue plasminogen activator (tPA) administration for ischemic stroke between 3 and 4.5 hours after onset was found to be safe and beneficial in the ECASS III trial. However, its use has remained controversial, and its benefit as applied in routine practice at community stroke centers is less well defined. Methods This retrospective database study compared safety and clinical outcomes in 500 patients given IV tPA either from 0 to 3 or 3 to 4.5 hours after onset at a high-volume community center from January 2008 to October 2012. Additional independent variables included for univariate and multivariate analysis were age, sex, hypertension, diabetes mellitus, National Institutes of Health stroke scale on arrival. Results There were no significant differences seen in rates of symptomatic intracranial hemorrhage (3.8% vs 5.8%, P > .05), in-hospital mortality, or Barthel index at 3 months between groups. In addition, tPA administration despite ECASS III contraindications did not appear to be an independent predictor of hemorrhage in the first 24 hours. Discussion Our results show that the conclusions of the ECASS III trial can be applied to routine stroke treatment at a community center and that IV thrombolysis in the 3- to 4.5-hour window results in similar safety and efficacy functional outcome at 3 months compared with administration before 3 hours after onset.