We used data from the Minnesota Stroke Registry to examine rates of intravenous thrombolytic therapy in acute ischemic stroke and identifed opportunities to improve the utilization of this treatment.
We analyzed a total of 1010 acute ischemic stroke patients who had been entered into the registry by 13 participating hospitals during the first three quarters of the 2008 calendar year.
Of the 1010 patients only 121 (12%) came within 2 hours of symptom onset. Intravenous recombinant tissue plasminogen activator (rt-PA) was administered to 32/55 (58%) of the patients who arrived within 2 hours of symptom onset and met eligibility criteria for this treatment. The remaining 66 patients had a documented reason for non-treatment. The most common reason (22/66) for non-treatment was rapid resolution of symptoms or mild stroke. Out of those 22 patients, 20 were ambulating independently prior to admission and only 9/20 (45%) ambulated independently at discharge.
Further community education on the need for immediate medical attention after stroke is needed. Patients appropriately excluded from rt-PA treatment due to mild deficits or rapidly improving symptoms seem to have poor discharge outcomes. This subgroup of patients will have to be studied further, preferably in the context of a clinical trial.
Keywords: Thrombolysis, acute stroke, ischemic stroke, registry, recombinant tissue plasminogen activator