Eligibility for recombinant tissue plasminogen activator in acute ischemic stroke: a population-based study.
OBJECTIVE
Acute ischemic stroke patients are infrequently treated with recombinant tissue plasminogen activator (rtPA). We present unique population-based data regarding the eligibility of ischemic stroke patients for rtPA treatment.


METHODS
All ischemic strokes presenting to an emergency department (ED) within a biracial population of 1.3 million were identified. The patient was considered eligible for rtPA on the basis of exclusion criteria from the National Institute of Neurological Disorders and Stroke rtPA trial.


RESULTS
Of 2308 ischemic strokes, 1849 presented to an ED. Only 22% of all ischemic strokes in the population arrived in the ED in <3 hours from symptom onset; of these, 209 (51%) were ineligible for rtPA on the basis of mild stroke severity, medical and surgical history, or blood tests.


CONCLUSIONS
In our population in 1993 to 1994, 8% of all ischemic stroke patients presented to an ED within 3 hours and met other eligibility criteria for rtPA. Even if time were not an exclusion for rtPA, only 29% of all ischemic strokes in our population would have otherwise been eligible for rtPA.
Kleindorfer
Dawn
D
Department of Neurology, University of Cincinnati College of Medicine, the Neuroscience Institute, OH 45267, USA. dawn.kleindorfer@uc.edu
Kissela
Brett
B
Schneider
Alex
A
Woo
Daniel
D
Khoury
Jane
J
Miller
Rosemary
R
Alwell
Kathleen
K
Gebel
James
J
Szaflarski
Jerzy
J
Pancioli
Arthur
A
Jauch
Edward
E
Moomaw
Charles
C
Shukla
Rakesh
R
Broderick
Joseph P
JP
D000208:Acute Disease; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D004608:Eligibility Determination; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D009820:Ohio; D018579:Patient Selection; D011994:Recombinant Proteins / Q000627:therapeutic use; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator