Why the study?
Does intravenous tissue plasminogen activator treatment for in-hospital stroke have similar treatment delays, safety, and efficacy compared to out-of-hospital stroke?
Does intravenous tissue plasminogen activator treatment for in-hospital stroke have similar treatment delays, safety, and efficacy compared to out-of-hospital stroke?
In-hospital strokes treated with IV-tPA experience significantly longer treatment delays compared to out-of-hospital strokes, although safety and efficacy appear similar.
Optimizing in-hospital stroke workflows is needed to minimize treatment delays; leaves open whether faster times improve outcomes.
BACKGROUND AND PURPOSE: In-hospital strokes (IHSs) are potential candidates for thrombolysis. We analyzed the treatment procedures, safety, and efficacy of intravenous tissue plasminogen activator (IV-tPA) in IHSs compared with out-of-hospital strokes (OHSs). METHODS: This study was based on a multicenter prospective registry of patients treated with IV-tPA divided into IHSs and OHSs. We recorded intrahospital delays and stroke outcomes. RESULTS: Among 367 patients treated with IV-tPA, 30 were IHSs. Baseline characteristics were similar except for a greater proportion of diabetes (36.7% vs 17.5%, P=0.01), cardiac failure (16.7% vs 5.3%, P=0.014), and atrial fibrillation (33.3% vs 17.5%, P=0.034) in IHSs than OHSs. In-hospital delays were significantly longer in IHSs for door-to-computed tomography time (39.5+/-18.7 vs 22.6+/-19.7 minutes, P<0.0001) and computed tomography-to-treatment time (92.0+/-26.1 vs 65.4+/-25.8 minutes, P<0.0001). No differences were observed in safety or efficacy. CONCLUSIONS: In-hospital procedures for thrombolysis proceed more slowly in IHSs than in OHSs. Thrombolysis is safe and efficient in IHS.
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Masjuán et al. (2008) studied this question.
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