Tissue plasminogen activator for acute stroke in everyday clinical practice

Thrombolysis for acute ischemic stroke has become a reality. The aim of our study was to assess the opportunity and practicality of establishing acute stroke treatment in a hospital that did not participate in acute stroke treatment trials, as well as to prospectively analyze 2 groups of patients who reached the Emergency Department (ED) within 3 hours who were either treated or not treated with tissue plasminogen activator (t-PA). The average score for severity of neurological deficits for the patients who received t-PA was 14 on the National Institute of Health Stroke Scale (NIHSS). We compare this group with 18 patients who did not receive t-PA but had similar NIHSS scores (13.9 average). Both groups were matched for age and other comorbidity factors. We concluded that the establishment of an acute stroke treatment algorithm is possible de novo in a hospital that is equipped with computed tomography (CT) and neurosurgery services. The number of patients who can receive t-PA treatment is limited by the strict inclusion and exclusion criteria. Prolonged door-to-needle time was caused by delays in CT interpretation, processing of laboratory results, and stabilization of blood pressure. Patients who received t-PA had a shorter length of stay, were more independent, and had a better survival rate after 1 year. Our findings were in agreement with the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Study that led to the approval of the use of t-PA in the treatment of acute ischemic stroke.