on July 17, 2008
Published online before print July 17, 2008, doi: 10.1161/STROKEAHA.107.512848
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Submitted on December 17, 2007
From the Departments of Neurology, Hospital Universitario Ramón y Cajal (J.M., M.E.N.-L., M.A.d.L.), Hospital Universitario Clínico San Carlos (P.S., J.A.E.), Hospital Universitario La Paz (B.F., E.D.-T.), and Hospital Universitario Gregorio Marañón (F.D.-O., A.G.-N.), Madrid, Spain. * To whom correspondence should be addressed. E-mail: jmasjuan.hrc{at}salud.madrid.org.
Background and Purpose—In-hospital strokes (IHSs) are potential candidates for thrombolysis. We analyzed the treatment procedures, safety, and efficacy of intravenous tissue plasminogen activator (IV-tPA) in IHSs compared with out-of-hospital strokes (OHSs). Methods—This study was based on a multicenter prospective registry of patients treated with IV-tPA divided into IHSs and OHSs. We recorded intrahospital delays and stroke outcomes. Results—Among 367 patients treated with IV-tPA, 30 were IHSs. Baseline characteristics were similar except for a greater proportion of diabetes (36.7% vs 17.5%, P=0.01), cardiac failure (16.7% vs 5.3%, P=0.014), and atrial fibrillation (33.3% vs 17.5%, P=0.034) in IHSs than OHSs. In-hospital delays were significantly longer in IHSs for door-to-computed tomography time (39.5±18.7 vs 22.6±19.7 minutes, P<0.0001) and computed tomography-to-treatment time (92.0±26.1 vs 65.4±25.8 minutes, P<0.0001). No differences were observed in safety or efficacy. Conclusions—In-hospital procedures for thrombolysis proceed more slowly in IHSs than in OHSs. Thrombolysis is safe and efficient in IHS.
Revised on January 18, 2008
Accepted on January 30, 2008
In-Hospital Stroke Treated With Intravenous Tissue Plasminogen Activator
Jaime Masjuan MD, PhD*;
Key words: intravenous tissue plasminogen activator • in-hospital stroke • stroke code • thrombolysis • stroke