From the Department of Neurology, University of Texas Houston Health
Science Center.
Correspondence to David Chiu, MD, Baylor College of Medicine, Department of Neurology, 6550 Fannin, Suite 1801, Houston, TX 77030. E-mail dchiu{at}bcm.tmc.edu
Background and Purpose—The feasibility, safety, and
efficacy of intravenous tissue plasminogen
activator (t-PA) for patients with acute ischemic
stroke in clinical practice need to be assessed.
Methods—We initiated a prospective open-label study at a
university hospital and two community hospitals in Houston, Tex,
immediately after the publication of the National Institute of
Neurological Disorders and Stroke (NINDS) t-PA study. A total of 30
patients, age 32 to 90 years, were treated with 0.9 mg/kg of
intravenous t-PA (maximum dose, 90 mg) within 3 hours of
acute ischemic stroke between December 1995 and December
1996.
Results—Six percent (6%) of all patients hospitalized with
ischemic stroke received intravenous t-PA at the
university hospital and 1.1% at the community hospitals. The rates of
total, symptomatic, and fatal intracerebral
hemorrhage were 10%, 7%, and 3%. Thirty-seven percent (37%)
of patients recovered to fully independent function. The average time
from stroke onset to emergency department arrival was 57 minutes;
emergency department arrival to computed tomography scan 41 minutes;
and computed tomography scan to administration of treatment 59
minutes.
Conclusions—When treatment guidelines are carefully
followed in an urban hospital setting, intravenous t-PA for
acute ischemic stroke is feasible and shows safety and efficacy
comparable to the results of the NINDS study.
© 1998 American Heart Association, Inc.
Original Contributions
Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke
Feasibility, Safety, and Efficacy in the First Year of Clinical Practice
Key Words: cerebral hemorrhage • cerebral infarction • emergency medical services • thrombolytic therapy
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