[Thrombolytic treatment in acute ischemic stroke in a center without previous experience. Development of internal organization and first results].
OBJECTIVE
Treatment of acute ischemic stroke within three hours with intravenous tissue-type plasminogen activator (t-PA) has been recently approved by the European Drug Agency. We present the development of an internal organization system that has permitted thrombolytic treatment in our center without previous experience as well as the results of the first year.


METHODS
Development of the thrombolysis educational program for the staff informed, of the internal organization system, and combined care protocols among the participating services. Prospective registry of patients treated with t-PA within the period 1/2004-2/2006. We collected demographic data, stroke assessment scales score (NIHSS), time to treatment, seven day and three months mortality, symptomatic hemorrhagic transformation, systemic bleedings, functional independency at three months, early significant improvement and significant deterioration.


RESULTS
Fifty-three patients were treated. Mean age: 65 +/- 13 years; 56% women. Mean NIHSS pre-treatment: 14 +/- 4.7. Mean time to hospital arrival: 62 +/- 40 minutes; door-to-treatment: 68 +/- 22 minutes, and mean time from stroke onset to treatment: 130 +/- 31 minutes. Symptomatic hemorrhagic transformation: 5.8%. Systemic bleeding: 3.8%. Seven day mortality: 5.6%; three months mortality: 15.1%. Early significant improvement: 51%. Significant neurological deterioration: 7.5%. Functional independency at three months: 51%.


CONCLUSIONS
Treatment of acute ischemic stroke within three hours with intravenous t-PA is safe and is associated with a favourable outcome when it is applied by neurologists specifically trained in acute stroke management.
Masjuan Vallejo
J
J
Servicio de Neurología, Hospital Ramón y Cajal, Madrid, España. jmasjuan.hrc@salud.madrid.org
Alonso de Leciñana Cases
M
M
García Barragán
N
N
Zarza Sanz
B
B
Díaz Sánchez
M
M
Martínez Castrillo
J C
JC
Corral Corral
I
I
D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology; D010043:Outcome and Process Assessment, Health Care; D013030:Spain; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents