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tPA use for Stroke in the Registry of the Canadian Stroke Network

Published online by Cambridge University Press:  02 December 2014

Janel O. Nadeau
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Steven Shi
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Jiming Fang
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Moira K. Kapral
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Janice A. Richards
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Frank L. Silver
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Michael D. Hill
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Abstract:

Background:

Thrombolytic therapy with recombinant tissue plasminogen activator (tPA) has been shown to be cost-effective and safe. Thrombolysis for stroke with tPA is now a standard of care in North America. However, it is only used on a small percentage of patients.

Methods:

The Registry of the Canadian Stroke Network was a consent-based stroke registry from 21 hospital sites across Canada. Using the thrombolysis data in phase 1 and 2 of the Registry, we sought to describe the use of stroke thrombolysis and its outcomes.

Results:

A total of 4107 patients were diagnosed with ischemic stroke in phase 1 and 2 of the Registry, of which 8.9% were treated with tPA. In consented tPA patients, the method of tPA administration was 85.8% IV only, 9.0% IA only, and 5.2% IV/IA combined. Patients had a median onset-to-treatment time of 167 minutes [IQR 140-188]. One quarter (25.5%) of eligible candidates (time from onset <150 minutes) were treated with tPA. Protocol violations occurred in 27.7% (67/242) of patients with 14.9% (10/67) mortality. Overall, in-hospital mortality was 11.6%. Lower Canadian Neurological Scale score and higher glucose level were predictive of mortality The symptomatic intracerebral hemorrhage (ICH) rate (phase 2 only) was 4.3%. The mean Stroke Impact Scale-16 score at six months was 73.2, approximately equivalent to a modified Rankin scale score of 2.

Conclusions:

At selected hospitals in Canada, thrombolysis use is higher than previously reported rates. Thrombolysis continues to be safe and effective in Canada.

Résumé:

RÉSUMÉ: Contexte:

La démonstration est faite que la thrombolyse au moyen de l’activateur du plasmagène tissulaire recombinant (rtPA) est rentable et sûre. La thrombolyse par le tPA pour traiter l’accident vasculaire cérébral (AVC) fait maintenant partie du traitement standard en Amérique du Nord. Cependant ce traitement n’est administré qu’à un petit nombre de patients.

Méthodes:

Le registre du Réseau canadien contre les accidents cérébro-vasculaires est un registre avec consentement de patients provenant de 21 hôpitaux canadiens. Au moyen des données sur la thrombolyse pendant les phases 1 et 2 du registre, nous décrivons l’utilisation de la thrombolyse dans l’AVC ainsi que les résultats de ce traitement.

Résultats:

4107 patients ont reçu un diagnostic d’AVC ischémique pendant les phases 1 et 2 du registre, dont 8,9% ont été traités par le rtPA. Parmi les patients qui ont donné leur consentement, le mode d’administration du rtPA était par voie IV seule chez 85,8%, par voie IA seule chez 9,0% et par voie IV et IA combinées chez 5,2%. Le délai médian entre le début de l’AVC et le traitement était de 167 minutes (intervalle interquartile de 140 à 188 minutes). Le quart des patients éligibles (25,5%), c’est à dire ceux chez qui moins de 150 minutes s’étaient écoulées depuis le début de l’AVC ont reçu du rtPA. Des dérogations au protocole sont survenues chez 27,7% des patients (67/242) avec une mortalité de 14,9% (10/67). Au total, la mortalité hospitalière était de 11,6%. Un score plus bas à l’Échelle neurologique canadienne et un taux plus élevé de glucose étaient les deux marqueurs prédisant la mortalité. Le taux hémorragie intracérébrale symptomatique était de 4,3% (phase 2 seulement). Le score moyen au stroke impact Scale-16 six mois plus tard était de 73,2, ce qui est à peu près équivalent à un score de 2 à l’échelle modifiée de Rankin.

Conclusions:

Le taux de thrombolyse est plus élevé que rapporté antérieurement dans certains centres hospitaliers canadiens. La thrombolyse demeure un traitement sûr et efficace au Canada.

Type
Original Article
Copyright
Copyright © The Canadian Journal of Neurological 2005

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