title: Thrombolysis in acute stroke: ongoing challenges based on a tertiary hospital audit and comparisons with other Australian studies.
abstract: OBJECTIVE
  Intravenous thrombolysis with tissue plasminogen activator (tPA) improves patient outcomes in acute ischaemic stroke. Because its benefit is time-dependant, treatment delays must be minimised. The aim of the present study was to review patient characteristics, timeliness of tPA delivery and clinical outcome in patients receiving t-PA in a tertiary hospital stroke unit in Queensland, and to compare the findings with those of other Australian studies.
  
  
  METHODS
  The present study was a retrospective study conducted between 1 January 2010 and 31 December 2012. Information was collected regarding demographics, stroke characteristics, timeliness of tPA delivery, clinical outcome, safety outcome and protocol deviation.
  
  
  RESULTS
  Of 490 patients admitted with ischaemic stroke, 57 (11.6%) received tPA. Compared with other studies, the patients in the present study had more severe stroke (median National Institutes of Health Stroke Scale (NIH SS) score), more cardioembolic strokes and more patients receiving tPA between 3 and 4.5 h of symptoms onset. Median symptom onset to treatment time was 175 min and median door to needle time was 97 min. At 3 months, 21.1% of patients had died and 41.5% had a favourable outcome (modified Rankin scale ≤ 2). Symptomatic intracerebral haemorrhage occurred in 5.3% of patients and protocol deviations occurred in 21.1%. Overall, delivery and outcomes of tPA at the Princess Alexandra Hospital were comparable to those reported in other Australian studies of usual care. Several challenges and strategies for optimal thrombolysis were identified, with supporting evidence from selected Australian sites.
  
  
  CONCLUSIONS
  The proportion of eligible stroke patients who receive tPA in a timely manner remains less than ideal at our centre. More accurate patient selection and reductions in treatment delays serve as targets for quality improvement efforts that have broad applicability.
authors.affiliation: Department of Internal Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: ; xxx.
authors.forename: Alex H T
authors.initials: AHT
authors.lastname: Lau
authors.affiliation: Department of Internal Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: ; xxx.
authors.forename: Graham
authors.initials: G
authors.lastname: Hall
authors.affiliation: Department of Internal Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: ; xxx.
authors.forename: Ian A
authors.initials: IA
authors.lastname: Scott
authors.affiliation: Department of Internal Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: ; xxx.
authors.forename: Marie
authors.initials: M
authors.lastname: Williams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011793:Queensland; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D062606:Tertiary Care Centers; D015912:Thrombolytic Therapy; D013997:Time Factors; D014481:United States
chemical_list: D005343:Fibrinolytic Agents