What percentage of individuals with acute ischemic stroke receive thrombolytic therapy when they arrive at an emergency room within three hours?

From the Guidelines

Approximately 31% of individuals with acute ischemic stroke receive thrombolytic therapy when they arrive at an emergency room within three hours, as seen in optimized settings like Helsinki University Central Hospital. This percentage is significantly higher than the average reported in other studies, highlighting the importance of optimized stroke unit care and timely access to thrombolysis 1. The recommended dose of intravenous tissue plasminogen activator (tPA, alteplase) is 0.9 mg/kg (maximum 90 mg), with 10% given as an initial bolus and the remainder infused over 60 minutes. Several factors contribute to the variability in treatment rates, including delayed patient arrival to the hospital, contraindications to tPA, uncertainty in diagnosis, and provider hesitation due to concerns about bleeding complications. Some key points to consider in improving thrombolytic therapy rates include:

• Streamlining in-hospital protocols to reduce delays in treatment
• Improving public awareness of stroke symptoms using the FAST acronym (Face drooping, Arm weakness, Speech difficulties, Time to call emergency services)
• Ensuring timely access to stroke unit care and thrombolysis
• Implementing automated monitoring and other innovative technologies to support acute stroke care 1. In contrast to the higher rate seen in optimized settings, a survey of 868 hospitals in 25 European countries revealed that on average only 3.3% of all acute ischemic stroke patients have access to thrombolysis 1. However, the most recent and highest quality study 1 suggests that with optimized care, a significantly higher percentage of patients can receive this life-saving treatment.

From the Research

Thrombolytic Therapy for Acute Ischemic Stroke

• The percentage of individuals with acute ischemic stroke who receive thrombolytic therapy when they arrive at an emergency room within three hours is not directly stated in the provided studies.
• However, a study published in 2010 2 found that 27.1% of patients who arrived at the emergency room within 60 minutes of stroke onset received intravenous thrombolytic therapy.
• Another study published in 2009 3 reported that the frequency of thrombolytic therapy administration significantly correlated with stroke center criteria, and that routine intravenous tPA protocol in the emergency room and supervision by the stroke center director significantly influenced the administration of thrombolytic therapy.
• A systematic review published in 2014 4 found that thrombolytic therapy, mostly administered up to six hours after ischemic stroke, significantly reduced the proportion of participants who were dead or dependent at three to six months after stroke, and that treatment within three hours of stroke was more effective in reducing death or dependency.

Factors Influencing Thrombolytic Therapy Administration

• The presence of a routine intravenous tPA protocol in the emergency room 3
• Supervision by the stroke center director 3
• Stroke center characteristics, such as the presence of stroke intensive care units and wards, and initiation of rehabilitation 3
• Time from stroke onset to arrival at the emergency room, with patients arriving within three hours being more likely to receive thrombolytic therapy 2, 4

Outcomes of Thrombolytic Therapy

• Reduced proportion of participants who were dead or dependent at three to six months after stroke 4
• Increased risk of symptomatic intracranial hemorrhage 4
• Increased risk of early death, mostly attributable to intracranial hemorrhage 4
• Improved recovery after stroke in some people, particularly those treated within three hours of stroke onset 5, 4