This Article Full Text Full Text (PDF) All Versions of this Article: 35/2/e27    most recent 01.STR.0000109767.11426.17v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kleindorfer, D. Search for Related Content PubMed PubMed Citation Articles by Kleindorfer, D. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Stroke Related Collections Acute Cerebral Infarction Emergency treatment of Stroke Thrombolysis

(Stroke. 2004;35:e27.)
© 2004 American Heart Association, Inc.

Research Reports

Eligibility for Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke

A Population-Based Study

Dawn Kleindorfer, MD; Brett Kissela, MD; Alex Schneider, MD; Daniel Woo, MD; Jane Khoury, MS; Rosemary Miller, RN; Kathleen Alwell, RN; James Gebel, MD; Jerzy Szaflarski, MD; Arthur Pancioli, MD; Edward Jauch, MD; Charles Moomaw, BS; Rakesh Shukla, PhD Joseph P. Broderick, MD for The Neuroscience Institute

From the Department of Neurology (D.K., B.K., A.S., D.W., J.K., R.M., K.A., J.G., J.S., C.M., J.B.), University of Cincinnati College of Medicine, the Neuroscience Institute; Department of Emergency Medicine (A.P., E.J.), University of Cincinnati College of Medicine; and Department of Environmental Health (R.S.), University of Cincinnati, Cincinnati, Ohio.

Reprint requests to Dawn Kleindorfer, MD, 231 Albert Sabin Way, Department of Neurology, No. 0525, University of Cincinnati, Cincinnati, OH 45267. E-mail dawn.kleindorfer{at}uc.edu

Background and Purpose— Acute ischemic stroke patients are infrequently treated with recombinant tissue plasminogen activator (rtPA). We present unique population-based data regarding the eligibility of ischemic stroke patients for rtPA treatment.

Methods— All ischemic strokes presenting to an emergency department (ED) within a biracial population of 1.3 million were identified. The patient was considered eligible for rtPA on the basis of exclusion criteria from the National Institute of Neurological Disorders and Stroke rtPA trial.

Results— Of 2308 ischemic strokes, 1849 presented to an ED. Only 22% of all ischemic strokes in the population arrived in the ED in <3 hours from symptom onset; of these, 209 (51%) were ineligible for rtPA on the basis of mild stroke severity, medical and surgical history, or blood tests.

Conclusions— In our population in 1993 to 1994, 8% of all ischemic stroke patients presented to an ED within 3 hours and met other eligibility criteria for rtPA. Even if time were not an exclusion for rtPA, only 29% of all ischemic strokes in our population would have otherwise been eligible for rtPA.

Key Words: eligibility determination • emergency treatment • stroke, acute • stroke, ischemic • tissue plasminogen activator

This article has been cited by other articles:

				S. Martin-Schild, H. Hallevi, K. C. Albright, A. M. Khaja, A. D. Barreto, N. R. Gonzales, J. C. Grotta, and S. I. Savitz Aggressive Blood Pressure-Lowering Treatment Before Intravenous Tissue Plasminogen Activator Therapy in Acute Ischemic Stroke Arch Neurol, September 1, 2008; 65(9): 1174 - 1178. [Abstract] [Full Text] [PDF]

				M O McCarron, M Armstrong, and P McCarron Potential for quality improvement of acute stroke management in a district general hospital Emerg. Med. J., May 1, 2008; 25(5): 270 - 273. [Abstract] [Full Text] [PDF]

				P. Khatri, R. A. Taylor, V. Palumbo, V. Rajajee, J. M. Katz, J. A. Chalela, A. Geers, J. Haymore, D. M. Kolansky, S. E. Kasner, et al. The safety and efficacy of thrombolysis for strokes after cardiac catheterization. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 906 - 911. [Abstract] [Full Text] [PDF]

				W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]

				A. Kobayashi, M. Skowronska, T. Litwin, and A. Czlonkowska Lack of experience of intravenous thrombolysis for acute ischaemic stroke does not influence the proportion of patients treated Emerg. Med. J., February 1, 2007; 24(2): 96 - 99. [Abstract] [Full Text] [PDF]

				V. Rajajee, C. Kidwell, S. Starkman, B. Ovbiagele, J. R. Alger, P. Villablanca, F. Vinuela, G. Duckwiler, R. Jahan, A. Fredieu, et al. Early MRI and outcomes of untreated patients with mild or improving ischemic stroke. Neurology, September 26, 2006; 67(6): 980 - 984. [Abstract] [Full Text] [PDF]

				T. I. Gropen, P. J. Gagliano, C. A. Blake, R. L. Sacco, T. Kwiatkowski, N. J. Richmond, D. Leifer, R. Libman, S. Azhar, M. B. Daley, et al. Quality improvement in acute stroke: The New York State Stroke Center Designation Project. Neurology, July 11, 2006; 67(1): 88 - 93. [Abstract] [Full Text] [PDF]

				K. Z. Bambauer, S. C. Johnston, D. E. Bambauer, and J. A. Zivin Reasons why few patients with acute stroke receive tissue plasminogen activator. Arch Neurol, May 1, 2006; 63(5): 661 - 664. [Abstract] [Full Text] [PDF]

				K D Hellier, J L Hampton, J V Guadagno, N P Higgins, N M Antoun, D J Day, J H Gillard, E A Warburton, and J-C Baron Perfusion CT helps decision making for thrombolysis when there is no clear time of onset. J. Neurol. Neurosurg. Psychiatry, March 1, 2006; 77(3): 417 - 419. [Abstract] [Full Text] [PDF]

				Y. Z. Deng, M. J. Reeves, B. S. Jacobs, G. L. Birbeck, R. U. Kothari, S. L. Hickenbottom, A. J. Mullard, S. Wehner, K. Maddox, A. Majid, et al. IV tissue plasminogen activator use in acute stroke: Experience from a statewide registry Neurology, February 14, 2006; 66(3): 306 - 312. [Abstract] [Full Text] [PDF]

				P. Schestatsky, P. D. Picon, D. O. Kleindorfer, P. Khatri, I. Katzan, and D. Cocho Reasons for exclusion from thrombolytic therapy following acute ischemic stroke Neurology, December 13, 2005; 65(11): 1844 - 1844. [Full Text] [PDF]

				Part 9: Adult Stroke Circulation, December 13, 2005; 112(24_suppl): IV-111 - IV-120. [Full Text] [PDF]

				L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, P. W. Duncan, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Circulation, March 1, 2005; 111(8): 1078 - 1091. [Full Text] [PDF]

				P. U. Heuschmann, P. L. Kolominsky-Rabas, J. Roether, B. Misselwitz, K. Lowitzsch, J. Heidrich, P. Hermanek, C. Leffmann, M. Sitzer, M. Biegler, et al. Predictors of In-Hospital Mortality in Patients With Acute Ischemic Stroke Treated With Thrombolytic Therapy JAMA, October 20, 2004; 292(15): 1831 - 1838. [Abstract] [Full Text] [PDF]