Extending tissue plasminogen activator use to community and rural stroke patients

José G. Merino, Brian Silver, Edward Wong, Blaine Foell, Bart M Demaerschalk, Arturo Tamayo, Fali Poncha, Vladimir Hachinski

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Background and Purpose - Guidelines for intravenous tissue plasminogen activator (tPA) use in stroke emphasize the importance of limiting its use to facilities with imaging capabilities and stroke expertise. This prospective case series set out to evaluate the safety of tPA use in patients referred from rural communities to a tertiary center. Methods - Prospective data of 82 consecutive patients treated with tPA in London, Ontario, were reviewed. Results - Twenty-three patients were transferred to London from a rural hospital (non-London patients); 49 were first evaluated in a London emergency room (London ER); and 10 were inpatients in a London hospital at the time of stroke onset. Mean transfer time and distance to London for non-London patients were 89 minutes and 41 miles. Although symptom onset to London ER times were longer for non-London than for London ER patients (123 versus 53 minutes), the door to needle times were significantly shorter for the former (49 versus 95 minutes, P<0.005). Imaging to needle times were longer for London inpatients compared with London ER patients (55 versus 36 minutes, P=0.16). The proportion of patients with >4-point improvement on the NIH Stroke Scale or cure at 24 hours was 57%, with no difference among groups (P=0.46). The overall symptomatic hemorrhage rate at 36 hours was 2%. No significant differences in outcomes were observed at 3 months. Conclusions - This prospective study suggests that it is feasible and safe to treat rural patients referred to a tertiary care center with tPA, thus extending the benefits of thrombolysis for acute stroke to a wider population.

Original languageEnglish (US)
Pages (from-to)141-146
Number of pages6
JournalStroke
Volume33
Issue number1
DOIs
StatePublished - 2002

Fingerprint

Tissue Plasminogen Activator
Rural Population
Stroke
Hospital Emergency Service
Rural Hospitals
Ontario
Tertiary Care Centers
Needles
Inpatients
Prospective Studies
Guidelines
Hemorrhage
Safety
Population

Keywords

  • Canada
  • Stroke management
  • Stroke, acute
  • Thrombolytic therapy
  • Tissue plasminogen activator

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Merino, J. G., Silver, B., Wong, E., Foell, B., Demaerschalk, B. M., Tamayo, A., ... Hachinski, V. (2002). Extending tissue plasminogen activator use to community and rural stroke patients. Stroke, 33(1), 141-146. https://doi.org/10.1161/hs0102.100481

Extending tissue plasminogen activator use to community and rural stroke patients. / Merino, José G.; Silver, Brian; Wong, Edward; Foell, Blaine; Demaerschalk, Bart M; Tamayo, Arturo; Poncha, Fali; Hachinski, Vladimir.

In: Stroke, Vol. 33, No. 1, 2002, p. 141-146.

Research output: Contribution to journalArticle

Merino, JG, Silver, B, Wong, E, Foell, B, Demaerschalk, BM, Tamayo, A, Poncha, F & Hachinski, V 2002, 'Extending tissue plasminogen activator use to community and rural stroke patients', Stroke, vol. 33, no. 1, pp. 141-146. https://doi.org/10.1161/hs0102.100481
Merino, José G. ; Silver, Brian ; Wong, Edward ; Foell, Blaine ; Demaerschalk, Bart M ; Tamayo, Arturo ; Poncha, Fali ; Hachinski, Vladimir. / Extending tissue plasminogen activator use to community and rural stroke patients. In: Stroke. 2002 ; Vol. 33, No. 1. pp. 141-146.
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