title: The use of intravenous recombinant tissue plasminogen activator in acute ischemic stroke.
abstract: We sought to determine the frequency of use of intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) in patients presenting to our institution with acute ischemic stroke (AIS). This observational study involved keeping a log of all patients presenting to our institution with symptoms consistent with AIS who were potential candidates for emergency thrombolysis over a 3-year period. The log included brain computed tomography (CT) scan results, whether or not rt-PA was administered, and contraindications to thrombolysis. It also included each patient's time flow through the system, from symptom onset to decision time regarding (and administration of) thrombolytics. Over the 36-month period of the study, there were 142 patients who presented to the Emergency Department (ED) who initially were thought to be potential candidates for thrombolysis for AIS. Ninety-five (68.5%) of these 142 patients had a confirmed diagnosis of AIS. On further clarification of symptom onset, 77 (81%) of these 95 patients with AIS actually presented within 3 h, and 17 (22%) of these 77 patients met criteria for thrombolysis and had no contraindications. All 17 (100%) patients with AIS presenting within 3 h of onset and without contraindications received i.v. rt-PA in the ED. In conclusion, i.v. rt-PA can be administered for AIS within the 3-h window if a hospital is committed to providing this treatment. Thrombolysis remains a treatment for a minority of AIS patients.
authors.affiliation: Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Kahn
authors.forename: Jason
authors.initials: J
authors.lastname: Viereck
authors.forename: Carlos
authors.initials: C
authors.lastname: Kase
authors.forename: Thomas
authors.initials: T
authors.lastname: Jeerakathil
authors.forename: Rafael
authors.initials: R
authors.lastname: Romero
authors.forename: Supriya D
authors.initials: SD
authors.lastname: Mehta
authors.forename: Robb
authors.initials: R
authors.lastname: Kociol
authors.forename: Viken
authors.initials: V
authors.lastname: Babikian
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D000075202:Contraindications; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator