Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke

Abstract

Background and Purpose-The feasibility, safety, and efficacy of intravenous tissue plasminogen activator (t-PA) for patients with acute ischemic stroke in clinical practice need to be assessed. Methods-We initiated a prospective open-label study at a university hospital and two community hospitals in Houston, Tex, immediately after the publication of the National Institute of Neurological Disorders and Stroke (NINDS) t-PA study. A total of 30 patients, age 32 to 90 years, were treated with 0.9 mg/kg of intravenous t-PA (maximum dose, 90 mg) within 3 hours of acute ischemic stroke between December 1995 and December 1996. Results-Six percent (6%) of all patients hospitalized with ischemic stroke received intravenous t-PA at the university hospital and 1.1% at the community hospitals. The rates of total, symptomatic, and fatal intracerebral hemorrhage were 10%, 7%, and 3%. Thirty-seven percent (37%) of patients recovered to fully independent function. The average time from stroke onset to emergency department arrival was 57 minutes; emergency department arrival to computed tomography scan 41 minutes; and computed tomography scan to administration of treatment 59 minutes. Conclusions-When treatment guidelines are carefully followed in an urban hospital setting, intravenous t-PA for acute ischemic stroke is feasible and shows safety and efficacy comparable to the results of the NINDS study. (Stroke. 1998;29:18-22.)

Acute Stroke Care in the US

“…11 Overall, between 3.0% and 8.5% of ischemic stroke patients were treated with rtPA in these pilot registries. These rtPA treatment rates are consistent with those reported in the other community-based or multi-hospital reports, [12][13][14][15][16][17][18][19][20] in which rtPA treatment rates among all ischemic stroke admissions have varied from 1.6% 15 to 9%, 16 with an average of Ϸ3% to 4%. Similarly, with the exception of 1 study, 14 post-treatment symptomatic ICH rates have ranged between 5% and 7% in these reports.…”

“…Similarly, with the exception of 1 study, 14 post-treatment symptomatic ICH rates have ranged between 5% and 7% in these reports. [12][13][14][15][16][17][18][19][20] In our data, symptomatic ICH complication rates were similar or even lower than these previous reports, giving further assurance that rtPA is being used with a high degree of safety in more community-based settings.…”

Benefits of a Prehospital Stroke Code System

“…Both in the overall group of acute stroke patients and in the subgroup of patients with cerebral infarction, the percentage of thrombolysis was significantly higher in patients in whom the stroke code was triggered, showing that activation of the stroke code reduced inhospital delays and improved the selection of patients eligible for thrombolysis. The percentage of patients who received t-PA was within the range of 1–7% reported by others [17,18,19,20, 30]. In a multicenter prospective study carried out in our country, 3.4% of patients were candidates for intravenous t-PA treatment within 3 h of stroke onset [33].…”

“…According to the literature, only 1–7% of patients with ischemic stroke receive thrombolytic therapy [17,18,19,20]. This low percentage is not only due to delayed hospital arrival, but also to the considerable number of stroke patients that are not eligible for thrombolysis.…”

Dehydroascorbic acid, a blood–brain barrier transportable form of vitamin C, mediates potent cerebroprotection in experimental stroke

“…A lthough stroke is the leading cause of permanent morbidity worldwide (1), current therapy is limited to thrombolysis, which has a narrow therapeutic window and requires sophisticated pretreatment imaging (2,3). The only Food and Drug Administration-approved therapy for acute ischemic stroke, i.v.…”