| Eligibility and rate of treatment for recombinant tissue plasminogen activator in acute ischemic stroke using different criteria. | |
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MedLine Citation:
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PMID: 21401790 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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ACADEMIC EMERGENCY MEDICINE 2011; 18:273-278 © 2011 by the Society for Academic Emergency Medicine ABSTRACT: Objectives: The rate of recombinant tissue plasminogen activator (rtPA) use for stroke is low among the Chinese-Taiwanese. The study objective was to determine if less restrictive exclusion criteria for rtPA would increase eligibility and the rate of treatment. Methods: This retrospective before-and-after study was conducted from 2006 to 2009. The authors compared stroke patients treated under the old rtPA exclusion criteria (January 2006 to December 2008) with those treated with less restrictive rtPA exclusion criteria (January to December 2009). Rates of eligibility and treatment and reasons for exclusion from rtPA between the two phases were assessed. Results: Of 461 eligible patients during the study period, 333 were evaluated by the old criteria and 128 were evaluated by the less restrictive criteria. Minor or improving stroke was the primary exclusion reason in both groups (194/333, 58% vs. 70/128, 55%). Eligibility for rtPA was increased in the less restrictive criteria (35/127, 27%, 95% confidence interval [CI] = 20% to 36%) compared to the old criteria (40/333, 12%, 95% CI = 8.7% to 16%; p = 0.0001). Fewer patients were excluded due to old age in the less restrictive criteria (0/128, 0%) compared to the old criteria (37/333, 11%; p = 0.0001). The rate of consent refusal increased in the less restrictive criteria (27/128, 21%, 95% CI = 14% to 29%) compared to the old criteria (23/333, 6.9%, 95% CI = 4.4% to 10%; p < 0.0001). Rate of rtPA treatment was unchanged between the less restrictive criteria (8/128, 6.3%, 95% CI = 2.7% to 12%) and the old criteria (17/333, 5.1%, 95% CI = 3% to 8%; p = 0.63). Conclusions: Increasing eligibility for rtPA does not increase the rate of treatment, possibly due to the high symptomatic intracerebral hemorrhage rate among Chinese-Taiwanese, which is a major concern among emergency physicians (EPs), neurologists, and patients. Dealing with perceived safety issues of rtPA is crucial before the rate of treatment can be increased. |
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Authors:
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Poyin Huang; Gim-Thean Khor; Chun-Hung Chen; Ruey-Tay Lin; Ching-Kuan Liu |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Volume: 18 ISSN: 1553-2712 ISO Abbreviation: Acad Emerg Med Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-03-15 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9418450 Medline TA: Acad Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 273-8 Citation Subset: IM |
Copyright Information:
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© 2011 by the Society for Academic Emergency Medicine. |
Affiliation:
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From the Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University (PH, GK, CC, RL, CL), Kaohsiung; the Master's Program in Neurology, College of Medicine, Kaohsiung Medical University (RL), Kaohsiung; and the Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital (CL), Kaohsiung, Taiwan. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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