Candidates for thrombolytic treatment in acute ischaemic stroke--where are our patients in Hong Kong?
OBJECTIVE
Tissue plasminogen activator (t-PA) has been approved by the Food and Drug Administration in the treatment of patients with acute ischaemic stroke presenting within three hours from onset of symptoms. This study aims to identify the potential number of stroke patients suitable for t-PA in Hong Kong.


METHODS
All patients with a clinical diagnosis of acute stroke were recruited. Data collected included demographics, vital signs, medical history, contraindications to thrombolysis, severity of stroke (Canadian neurological scale), time course from onset of symptoms to computed tomography, computed tomography results, and final diagnoses by physicians.


RESULTS
During the five month study period, 201 patients were recruited and nine were subsequently excluded from further analysis because computed tomography was not performed. Their mean age was 70.9 (range from 41-91) years. Eighty (41.7%) and 100 (52.1%) patients presented to our emergency department within two hours and three hours respectively from symptom onset. The mean severity score (Canadian neurological scale) was 7.83 (out of a maximum of 11.5). A total of 132 (68.8%) patients had acute ischaemic stroke confirmed by computed tomography. Mean delay in computed tomography was 4.91 hours. Fourteen (7.3%) and 52 (27.1%) of all patients had computed tomography of the brain done within one and two hours respectively. Only 20 patients (10.45%) could meet the three hour criteria as stated in the National Institute of Neurologic Disorders and Stroke rt-PA stroke study and seven (3.6%) of them were confirmed to have acute ischaemic stroke. Two patients were further excluded because of high systolic blood pressure and current warfarin medication.


CONCLUSIONS
At present very few patients could benefit from thrombolytic treatment. Delays in the chain of recovery in stroke management should be identified and corrected.
Siu
Y C
YC
Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China. axel@hknet.com
Wong
T W
TW
Lau
C C
CC
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator