Effectiveness of t-PA in acute ischemic stroke

Buchan, Alastair; Barber, Philip A.; Newcommon, Nancy; Karbalai, H; Demchuk, Andrew M.; Hoyte, Keith; Klein, Gary; Feasby, Thomas E.

doi:10.1212/wnl.54.3.679

Cited by 116 publications

(80 citation statements)

References 38 publications

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“…The door to needle times for our patients are comparable to those reported in other series, 2,4,10,19 and those for patients transferred from rural hospitals were within the 1 hour recommended by guidelines. 20 This was significantly shorter than times for patients who presented directly to a London hospital.…”

Section: Discussionsupporting

confidence: 89%

“…The outcomes in our patients are comparable with those of the NINDS trial, 1 and they contribute to the growing number of studies that have demonstrated the safety and effectiveness of tPA when used in routine clinical practice. 2,4,5,10,19 Given the geographic location of London, the demographic characteristics of southwestern Ontario, and the fiscal constraints of the Canadian health system, our stroke team must provide stroke care coverage to a large geographical area. Other centers have reported successes with the use of tPA in rural settings or in settings where access to neurologists and imaging facilities is limited.…”

Section: Discussionmentioning

confidence: 99%

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Extending Tissue Plasminogen Activator Use to Community and Rural Stroke Patients

Merino

Silver

Wong

et al. 2002

Stroke

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Background and Purpose-Guidelines for intravenous tissue plasminogen activator (tPA) use in stroke emphasize the importance of limiting its use to facilities with imaging capabilities and stroke expertise. This prospective case series set out to evaluate the safety of tPA use in patients referred from rural communities to a tertiary center. Methods-Prospective data of 82 consecutive patients treated with tPA in London, Ontario, were reviewed. Results-Twenty-three patients were transferred to London from a rural hospital (non-London patients); 49 were first evaluated in a London emergency room (London ER); and 10 were inpatients in a London hospital at the time of stroke onset. Mean transfer time and distance to London for non-London patients were 89 minutes and 41 miles. Although symptom onset to London ER times were longer for non-London than for London ER patients (123 versus 53 minutes), the door to needle times were significantly shorter for the former (49 versus 95 minutes, PϽ0.005). Imaging to needle times were longer for London inpatients compared with London ER patients (55 versus 36 minutes, Pϭ0.16). The proportion of patients with Ͼ4-point improvement on the NIH Stroke Scale or cure at 24 hours was 57%, with no difference among groups (Pϭ0.46). The overall symptomatic hemorrhage rate at 36 hours was 2%. No significant differences in outcomes were observed at 3 months. Conclusions-This prospective study suggests that it is feasible and safe to treat rural patients referred to a tertiary care center with tPA, thus extending the benefits of thrombolysis for acute stroke to a wider population. Key Words: Canada Ⅲ stroke, acute Ⅲ stroke management Ⅲ thrombolytic therapy Ⅲ tissue plasminogen activator T he National Institute of Neurological Disorders and Stroke (NINDS) tPA Stroke Study Group showed in 1995 that intravenous tissue plasminogen activator (tPA) was an efficacious treatment for acute ischemic stroke. 1 Since its approval by the FDA in 1996, tPA has been used safely and effectively in routine clinical practice in urban academic medical centers 2-7 and in community hospitals. 2,8 Strategies to extend thrombolysis to rural community hospitals with imaging and intensive care facilities but with limited stroke expertise 5,9 and referral protocols for urban community hospitals that have limited access to imaging facilities 10 have been implemented successfully.Guidelines have been developed to ensure safety in the use of tPA for acute ischemic stroke. [11][12][13] Routine tPA use is currently restricted to those patients who can be treated within 3 hours of symptom onset. All the guidelines emphasize the importance of involving physicians with expertise in the diagnosis of stroke and in the interpretation of CT scans and restrict treatment to facilities that have the ability to handle hemorrhagic complications. Many hospitals, particularly outside the United States, 10,14 lack the staff or the facilities required to meet these criteria.In February 1999, the Health Protection Branch of Canada granted a ...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Extending Tissue Plasminogen Activator Use to Community and Rural Stroke Patients

Merino

Silver

Wong

et al. 2002

Stroke

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“…3), and was similar to rates in other reported series. [26][27][28][29][30][31][32][33][34][35][36] Serious adverse events occurred in 75 (6.6%) of the patients (95% CI 5.2%-8.2%) ( Table 3). Of the 52 (4.6%) who had a symptomatic intracranial hemorrhage, 39 (75%) died in hospital.…”

Section: Resultsmentioning

confidence: 99%

Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study

Hill¹

2005

Canadian Medical Association Journal

421

284

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“…Con respecto al segundo caso clínico, el uso de rt-PA para fibrinólisis en casos de ACV isqué-micos agudos tiene una efectividad conocida en cuanto a recuperar la independencia del paciente y un margen de seguridad aceptable si se realiza según protocolos establecidos 14,15 . La evolución clínica favorable y la disolución del trombo en este paciente con un tratamiento médico (y no quirúrgico como en el primer caso) demostraron que la decisión de iniciar heparina fue la adecuada.…”

Section: Discussionunclassified

Accidente cerebrovascular isquémico en pacientes con trombo intracavitario: Experiencia con tratamientos distintos en fase aguda

Oberreuter¹,

Silva²,

Caba³

et al. 2014

Rev. méd. Chile

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Effectiveness of t-PA in acute ischemic stroke

Abstract: The use of t-PA for stroke in this community is effective with a number needed to treat of six. The risk of symptomatic hemorrhage is similar to that noted in randomized trials. Treating patients who violate protocol results in excess risk with no observable benefit.

Cited by 116 publications

References 38 publications

Extending Tissue Plasminogen Activator Use to Community and Rural Stroke Patients

Extending Tissue Plasminogen Activator Use to Community and Rural Stroke Patients

Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study

Accidente cerebrovascular isquémico en pacientes con trombo intracavitario: Experiencia con tratamientos distintos en fase aguda

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