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IV tPA use for acute ischemic stroke in an inner city community hospital Full Text
Journal of Emergencies, Trauma and Shock, 08/19/2011
Baron R et al. – Tissue plasminogen activator use in an inner city non–university hospital provided a positive outcome in a large percentage of patients with ischemic stroke, though increased risk in the cerebral hemorrhage may limit its usefulness.
Methods- This is a retrospective case series of all patients receiving tPA for ischemic stroke in an urban non–university hospital in Chicago, Illinois, since 2005.
- 23 patients received tPA during the study period.
- The mean age was 69 years with 60% being males.
- The mean time from symptom onset to ER presentation was 61 minutes.
- The average time from ER presentation to tPA administration was 78 minutes.
- Two protocol violations occurred, both due to elevated blood pressure, but neither had a tPA–related complication.
- Five patients (22%) suffered a tPA–related complication, three of which (13%) were cerebral hemorrhages of which one was asymptomatic.
- This is a cerebral hemorrhage rate approximately double that reported in the original study of tPA use for ischemic stroke.
- Two patients died, neither was due to a hemorrhagic complication.
- The median NIHSS at presentation and at 24 hours were 14 and 6, respectively.
- Positive outcome (NIHSS improvement by 4 points) was seen in 11 patients (48%).
