title: TPA use for stroke in the Registry of the Canadian Stroke Network.
abstract: BACKGROUND
  Thrombolytic therapy with recombinant tissue plasminogen activator (tPA) has been shown to be cost-effective and safe. Thrombolysis for stroke with tPA is now a standard of care in North America. However, it is only used on a small percentage of patients.
  
  
  METHODS
  The Registry of the Canadian Stroke Network was a consent-based stroke registry from 21 hospital sites across Canada. Using the thrombolysis data in phase 1 and 2 of the Registry, we sought to describe the use of stroke thrombolysis and its outcomes.
  
  
  RESULTS
  A total of 4107 patients were diagnosed with ischemic stroke in phase 1 and 2 of the Registry, of which 8.9% were treated with tPA. In consented tPA patients, the method of tPA administration was 85.8% i.v. only, 9.0% ia only, and 5.2% i.v./i.a. combined. Patients had a median onset-to-treatment time of 167 minutes [IQR 140-188]. One quarter (25.5%) of eligible candidates (time from onset <150 minutes) were treated with tPA. Protocol violations occurred in 27.7% (67/242) of patients with 14.9% (10/67) mortality. Overall, in-hospital mortality was 11.6%. Lower Canadian Neurological Scale score and higher glucose level were predictive of mortality The symptomatic intracerebral hemorrhage (ICH) rate (phase 2 only) was 4.3%. The mean Stroke Impact Scale-16 score at six months was 73.2, approximately equivalent to a modified Rankin scale score of 2.
  
  
  CONCLUSIONS
  At selected hospitals in Canada, thrombolysis use is higher than previously reported rates. Thrombolysis continues to be safe and effective in Canada.
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Janel O
authors.initials: JO
authors.lastname: Nadeau
authors.forename: Steven
authors.initials: S
authors.lastname: Shi
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.forename: Janice A
authors.initials: JA
authors.lastname: Richards
authors.forename: Frank L
authors.initials: FL
authors.lastname: Silver
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
mesh_terms: D002170:Canada; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D019983:Guideline Adherence; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator