Why the study?
Despite evidence that t-PA improves stroke outcomes if administered early, less than 5% of stroke patients in many parts of North America receive it, indicating a need to improve thrombolysis rates.
May support Telestroke expansion for acute rural stroke; leaves open quantitative outcome trials in chronic CVD.
Studies with tissue plasminogen activator (t-PA) published in 1995 showed significant improvement in stroke outcome if the drug was administered within 3 hours from stroke onset. Several recent reports, however, show that less than 5% of stroke patients may be receiving t-PA in many parts of North America. This paper explores how this may be improved by examining some of the steps taken in Canada, where a recent audit showed that 8.2% of ischemic stroke patients received t-PA, and in those arriving within 2.5 hours to regional stroke centers in Ontario, 42.2% received t-PA. The paper also reviews the potential for t-PA to be given by more physicians, in remote regions using Telestroke, the possibility for using imaging characteristics rather than the onset of stroke as a determinant of eligibility for t-PA, the status of contraindications for thrombolysis, and the possibility of combining t-PA with immune modulation for improved stroke outcomes.
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Antoine M. Hakim (2012) conducted a review in Cardiovascular disease (n=37). Virtual care technologies vs. Traditional in-person care was evaluated on Effectiveness of virtual care systems, feasibility, and stakeholder perceptions.
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