title: Tissue plasminogen activator (rt-PA) in acute ischemic stroke: Outcomes associated with ambulation.
abstract: OBJECTIVE
  Several clinical trials have highlighted general favorable outcomes of intravenous tissue type plasminogen activator (rt-PA) in acute ischemic stroke using different measures including, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Findings from most of these measures indicate that the benefits of rt-PA are time dependent, thus, supporting intensive efforts to fast-track hospital thrombolytic treatment in patients with stroke. Despite the widespread benefits of rt-PA, the effectiveness of this therapy on specific functions such as ambulatory performance of the recovering stroke patient is not fully investigated. We aim to investigate this issue in the current study.
  
  
  METHODS
  We analyzed data from a retrospective cohort of acute ischemic stroke patients admitted to Greenville Health System (GHS) between 2010-2013. We identified patients who received rt-PA within a 4.5 hour time frame following the onset of acute ischemic stroke symptoms. Our analysis compared ambulatory variables and hospital-level characteristics in proportions of patients receiving rt-PA with those not receiving rt-PA. This analysis determined whether early treatment with rt-PA is associated with favorable changes in ambulatory status from admission to discharge following acute ischemic stroke.
  
  
  RESULTS
  Among 663 patients with ischemic stroke who were eligible to receive rt-PA, 241 patients received rt-PA and 422 patients did not due to several risk factors. We found a statistically significant difference (P < 0.001) for changes in ambulation status from hospital admission to discharge between patients receiving rt-PA and patients who did not receive rt-PA. Among patients who received rt-PA, 27.8% improved in their ambulation status, 41.9% saw no change in their ambulation status, 0.4% worsened in their ambulation status, and 29.9% were unable to be determined. Of the patients who did not receive rt-PA, 20.1% improved in their ambulation status, 61.8% saw no change in their ambulation status, 1.4% worsened in their ambulation status, and 16.6% were unable to be determined.
  
  
  CONCLUSIONS
  Our current study indicates that early treatment with rt-PA may be associated with favorable changes in ambulatory status from admission to discharge following acute ischemic stroke.
authors.affiliation: University of South Carolina School of Medicine, SC, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Lawson
authors.affiliation: University of South Carolina School of Medicine, SC, USA.
authors.forename: I E
authors.initials: IE
authors.lastname: Brown
authors.affiliation: University of South Carolina School of Medicine, SC, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Westerkam
authors.affiliation: Greenville Health System, SC, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Blackhurst
authors.affiliation: Greenville Health System, SC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sternberg
authors.affiliation: Greenville Health System, SC, USA.
authors.forename: R
authors.initials: R
authors.lastname: Leacock
authors.affiliation: University of South Carolina School of Medicine, SC, USA.
authors.forename: T I
authors.initials: TI
authors.lastname: Nathaniel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects* / Q000502:physiology; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Ambulation; acute ischemic stroke; tissue plasminogen activator (rt-PA)