Thromboyytic therapy for acute ischaemic stroke : successful implementation in an Australian tertiary hospital

Bray, Janet, Coughlan, Kelly and Bladin, Christopher 2006, Thromboyytic therapy for acute ischaemic stroke : successful implementation in an Australian tertiary hospital, Internal medicine journal, vol. 36, no. 8, pp. 483-488, doi: 10.1111/j.1445-5994.2006.01127.x.

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Title Thromboyytic therapy for acute ischaemic stroke : successful implementation in an Australian tertiary hospital
Author(s) Bray, Janet
Coughlan, Kelly
Bladin, Christopher
Journal name Internal medicine journal
Volume number 36
Issue number 8
Start page 483
End page 488
Publisher Wiley-Blackwell Publishing Asia
Place of publication Richmond, Vic.
Publication date 2006-08
ISSN 1444-0903
Keyword(s) stroke
cerebrovascular accident
thrombolytic therapy
tissue plasminogen activator
Summary Background: The use of tissue-type plasminogen activator (t-PA) in ischaemic stroke outside of experienced stroke centres remains controversial. The aim of this study was to present the initial experience with t-PA in patients with ischaemic stroke at an institution with no prior experience in i.v. stroke thrombolysis and to compare results to published reports.

Methods: Prospective audit of 888 patients with consecutive stroke and transient ischaemic attack admitted to a 426-bed tertiary referral hospital from March 2003 to October 2005. Main outcome measures were treatment rate, exclusion criteria, protocol violations, intracerebral haemorrhage, disability (modified Rankin scale) and mortality at 3 months.

Results: Over the study period, 72 patients received t-PA (11% of ischaemic strokes). The main reason for exclusion was presentation beyond 3 h of onset (44%); if all eligible patients had arrived within 3 h, treatment rate was estimated at 32.5%. Protocol violations occurred in 15 (21%) patients. There were seven (10%) asymptomatic intracerebral haemorrhage and one (1%) non-fatal symptomatic intracerebral haemorrhage. At 3 months, 37% had achieved excellent recovery (modified Rankin scale 0–1) and seven (10%) had died. The delivery and outcomes associated with the use of t-PA were comparable to the results of the National Institute of Neurological Disorders and Stroke trial and meta-analysis of open-labelled studies.

Conclusion: With appropriate infrastructure and protocols, previously inexperienced tertiary referral centres can replicate the experience and outcome measures reported by clinical trials of t-PA in patients with stroke.
Language eng
DOI 10.1111/j.1445-5994.2006.01127.x
Field of Research 111004 Clinical Nursing: Tertiary (Rehabilitative)
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2006, The Authors
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Document type: Journal Article
Collections: Faculty of Health
School of Nursing and Midwifery
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