Document Detail


Intravenous tissue plasminogen activator for acute ischemic stroke: A Canadian hospital's experience.
MedLine Citation:
PMID:  11108749     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: In the United States, tissue plasminogen activator (tPA) was approved for treatment of acute ischemic stroke in 1996. Its use has only recently been approved in Canada. We sought to evaluate the safety, feasibility, and efficacy of treatment in a Canadian hospital setting. METHODS: A combined retrospective and prospective review is presented of 46 consecutive patients treated with intravenous tPA at our hospital with a treatment protocol similar to that of the National Institute of Neurological Disorders and Stroke (NINDS) trial. RESULTS: Symptomatic intracranial hemorrhage at 36 hours occurred in 1 patient (2.2%). The median time to treat was 165 minutes, with a median "door-to-needle" time of 84 minutes. Compared with patients presenting initially at our hospital, patients transferred from another institution for tPA therapy were treated closer to the 3-hour time window (mean 173 versus 148 minutes, P:<0.001) but had a shorter door-to-needle time (43 versus 102 minutes, P:<0.001). For every 10 minutes closer to the 3-hour time window that any patient arrived at the hospital, 7 minutes was saved in the door-to-needle time (correlation coefficient 0.9, P:<0.001). Patient outcome did not differ from that in the NINDS trial (P:>0.75). CONCLUSIONS: Our safety and patient outcome data compare favorably with NINDS and Phase IV data. Although a 3-hour treatment window was feasible, the median door-to-needle time lengthened as more treatment time was available and the door-to-needle time was beyond recommended standards. This review has prompted changes in our community to improve treatment efficiency.
Authors:
K M Chapman; A R Woolfenden; D Graeb; D C Johnston; J Beckman; M Schulzer; P A Teal
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  31     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2000 Dec 
Date Detail:
Created Date:  2000-12-14     Completed Date:  2001-02-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2920-4     Citation Subset:  IM    
Affiliation:
Division of Neurology, Vancouver Hospital and Health Sciences Center, University of British Columbia, Vancouver, Canada.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Brain / radiography
Canada
Cerebral Infarction / drug therapy,  radiography
Female
Fibrinolytic Agents / administration & dosage,  therapeutic use*
Humans
Injections, Intravenous
Male
Middle Aged
Prospective Studies
Randomized Controlled Trials as Topic
Retrospective Studies
Stroke / drug therapy*,  radiography
Time Factors
Tissue Plasminogen Activator / administration & dosage,  therapeutic use*
Tomography, X-Ray Computed / statistics & numerical data
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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