Alteplase for acute ischemic stroke: 2 years in a community hospital without previous experience in stroke thrombolysis

Introduction

Intravenous administration of recombinant tissue plasminogen activator (rt-PA) remains the most beneficial proven intervention for emergency treatment of stroke. The objective of the present study was to assess the implementation of the 'Stroke code' in routine clinical care at our center in the last 2 years and to describe the clinical outcome of patients who received treatment with intravenous rt-PA.

Methods

The aim of the 'Stroke code' is the early recognition of selected patients with a suspected stroke who may be treated with thrombolysis therapy. Prehospital emergency medical services, critical care, radiology and neurology departments are implicated. Inclusion criteria for intravenous administration of rt-PA (0.9 mg/kg) were: age 18 years or greater, measurable neurological deficit, NIHSS >4 and <25, onset of symptoms <3 hours before beginning treatment, CT without a multilobar infarction (hypodensity >1/3 cerebral hemisphere).

Results

Fifty-five 'Stroke codes' were activated from November 2005 to November 2007. rt-PA was administered in 27 patients (49%), 21 patients were males and six females. The mean age was 64 years. APACHE II (admission) score was 8.8 ± 3.5 points. ICU length of stay was 3.5 ± 1.5 days. Eighty-eight percent of patients had vascular risk factor, 33.3% were receiving aspirin at stroke onset.

Post-treatment study imaging was performed 48 hours after thrombolysis: three patients developed CT haemorrhagic infarct type 1 (asymptomatic small petechiae along the margins of the infarct). Two patients died, because of cerebral infarction with cerebral edema. The median NIHSS score was 12.8 points at admission and 10.2, 8 and 7.2 at 2 hours, 24 hours and 48 hours after treatment, respectively.

Conclusion

In selected patients rt-PA is effective when used within 3 hours of stroke onset [1]. rt-PA is safe in routine clinical use despite limited prior experience of thrombolysis for acute stroke [2].