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Withholding recombinant tissue-type plasminogen activator linked with poor outcomes
Smith E. Stroke. 2011;doi:10.1161/STROKEAHA.111.613208.
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Patients who did not receive intravenous recombinant tissue-type plasminogen activator because of mild or improving stroke had poor short-term outcomes, according to a study.
Between 2003 and 2009, 693,418 patients were admitted through the ED with ischemic stroke or transient ischemic attack. There were 148,068 (21.3%) patients whose symptom onset was within 2 hours of their arrival, making them eligible for recombinant tissue-type plasminogen activator (rt-PA). Medical records were reviewed when rt-PA was not administered, and researchers kept track of NIH Stroke Scale scores recorded in the ED.
Of 148,068 patients, 93,517 were diagnosed with ischemic stroke and 54,551 with TIA, according to the study. Of patients diagnosed with ischemic stroke, 26% (n=24,292) received IV rt-PA, 31.2% (n=29,200) did not receive rt-PA because of mild or improving stroke, 28.8% (n=26,891) did not receive rt-PA because of other reasons, and 14% (n=13,134) did not receive rt-PA, with no reason documented. There were 8,272 of the 29,200 patients with mild or improving stroke not treated with rt-PA who could not be discharged to home because of death (1.1%), discharge to hospice (0.8%), discharge to a skilled nursing facility (10.7%) or discharge to acute rehabilitation (15.7%). Patients with mild or improving stroke not treated with IV rt-PA were more likely to have history of prior stroke and dyslipidemia, and less likely to have history of atrial fibrillation vs. patients who received IV rt-PA, according to researchers.
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