Intravenous thrombolytic therapy for acute ischemic stroke: the experience of a community hospital.
OBJECTIVE
Tissue plasminogen activator (tPA) is a standard therapy for acute ischemic stroke (AIS) but only limited data are noted in Taiwan. The purpose of this study was to assess the safety, feasibility, and efficacy of treatment in a community hospital setting.


METHODS
We retrospectively reviewed the medical records of all patients who had received intravenous tPA therapy from 1998 to 2007 in our hospital. We compared the characteristics, complications, and outcomes in our patients with those of patients in the National Institute of Neurological Disorders and Stroke (NINDS) trial.


RESULTS
A total of 43 patients were reviewed with a mean age of 63 years and a male predominance (64%). The median pretreatment National Institutes of Health Stroke Scale score was 18. In our patients, cardioembolism was the leading course of the strokes. The mean time from stroke onset to treatment was 134 minutes, and the mean door-to-computed tomography-time was 34 minutes while the mean door-to-needle time was 93 minutes. Within 36 hours symptomatic intracerebral hemorrhage occurred in two patients (4.7%). Four patients (9.3%) developed brain herniation with fatality. At follow-up, fourteen patients (33%) had a favorable outcome on the modified Rankin Scale (0-1). Patient outcome was not significantly different from that in the NINDS trial.


CONCLUSIONS
Although the number of patients with AIS receiving tPA in this study was small, thrombolytic therapy can be performed safely and effectively by physicians in the community hospital setting.
Hsu
Yung-Chu
YC
Department of Neurology, Chia-Yi Christian Hospital, Chiayi, Taiwan.
Sung
Sheng-Feng
SF
Ong
Cheung-Ter
CT
Wu
Chi-Shun
CS
Su
Yu-Hsiang
YH
D000203:Activities of Daily Living; D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006764:Hospitals, Community; D006801:Humans; D007275:Injections, Intravenous; D020766:Intracranial Embolism / Q000150:complications; D020767:Intracranial Thrombosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D013624:Taiwan; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator