scholarly journals Barriers to Receiving Tissue Plasminogen Activator in Patients with Ischemic Stroke

2021 ◽  
Vol 25 (1) ◽  
pp. 11-18
Author(s):  
Monirsadat Mirzadeh ◽  
◽  
Hossein Mozhdehipanah ◽  
Ali Emami ◽  
Niloofar Motamed ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Public Awareness ◽  
Demographic Data ◽  
Cerebrovascular Diseases ◽  
Time Of Arrival ◽  
Cross Sectional ◽  
Tissue Plasminogen

Background: Cerebrovascular diseases are the second common cause of mortality worldwide. The onset of reperfusion in the first 3-4.5 hours is a predictive factor of treatment. Objective: The present study investigated barriers to receiving tissue plasminogen activator in patients with ischemic stroke. Methods: This cross-sectional study examined 191 patients with first-ever stroke referring to the emergency department of the Persian Gulf Martyrs Hospital of Bushehr City, Iran, in 2016. One checklist was completed which included demographic data, history of diseases, knowledge of stroke symptoms, and intervals regarding the onset of symptoms to informing emergency, informing emergency on arrival at the emergency department of the hospital, and making the diagnosis for the patients. The obtained data were analyzed in SPSS v. 19. Results: Mean±SD age of the patients was 65.92±12.48 years. The majority of patients under investigation (55.5%) were female, 63.4% were married, 56% were illiterate and 72.3% resided in other districts of Bushehr province. Mean duration between onset of symptoms and arrival at emergency department, onset of symptoms and call the emergency service, time of arrival at emergency department to perform brain Computer Tomography (CT) scan and also to be counseled by a neurologist were 699.66, 195.51, 45.11 and 423.62 minutes, respectively. Finally 14.6 percent of patients were qualified to be treated with tPA. Conclusion: The main barrier to timely therapy is a delay in golden time. Therefore, public education to promote public awareness could be of great benefit in reducing the referral delay time.

scholarly journals A clinical study investigation the three months prognosis of patients with ischemic stroke treated with recombinant tissue plasminogen activator (rtPA) and its effective factors

2019 ◽  
Vol 5 (2) ◽  
pp. 47-50
Author(s):  
Vahid Abbasi ◽  
Abolfazl Atalu ◽  
Afshan Sharghi ◽  
Fatemeh Taghvatalab
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Recombinant Tissue Plasminogen Activator ◽  
Close Monitoring ◽  
Cross Sectional ◽  
Admission Time ◽  
Tissue Plasminogen ◽  
The Mean

Objective: Currently, treating ischemic stroke by intravenous thrombolytic therapy has acceptable results in patients with stroke. This study aimed to evaluate the three months prognosis of patients treated with recombinant tissue plasminogen activator (rt-PA). Methods: This cross-sectional prospective study was conducted on 30 patients with cerebral ischemic stroke with the National Institutes of Health Stroke Scale (NIHSS) >5. Data such as demographic information, signs and symptoms, medical history, risk factors, focused neurological examination, and the NIHSS were collected for all patients. Then, all patients received 0.9 mg/kg of rt-PA as intravenous bolus doses and intravenous infusion under close monitoring in the emergency department. All patients were checked for necessary outcomes and also disability at the admission time, 7 days later and after three months all patients were checked again. All collected data were analyzed by appropriate tests using SPSS version 22. Results: Of all patients, 63.3% were males and 36.7% were females. The mean age of the patients was 62.37 ± 12.62 years with a range of 40-91 years. The mean of NIHSS was 12.46 ± 4.28 at admission time, in day seven it was 8.06 ± 3.72 and in month three after treatment it was 3.62 ± 2.31. There was a significant relationship between age, place of residence and NIHSS. Thirty percent of patients had NIHSS more than 15 at admission time and after 7 days this rate reached to 10% and three months later it declined to 6.7%. These differences were statistically significant. Conclusion: Intravenous thrombolytic therapy is associated with proper short term results in most patients with ischemic stroke.

Abstract WP280: Use of Strategies to Improve Door-to-Needle Times with Tissue Plasminogen Activator in Acute Ischemic Stroke by US Hospitals: Findings from the Target: Stroke Survey

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Gregg C Fonarow ◽  
Eric E Smith ◽  
Xin Zhao ◽  
Eric D Peterson ◽  
Ying Xian ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Ct Scanner ◽  
Critical Pathways ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Background: The benefits of intravenous tissue-plasminogen activator (tPA) in acute ischemic stroke are time-dependent and several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are utilizing these strategies has not been well studied. Methods: We surveyed 304 hospitals joining Target: Stroke regarding their baseline use of strategies to reduce door-to-needle times in the 1/2008-2/2010 timeframe (prior to the initiation of Target: Stroke). The survey was developed based on literature review and expert consensus for strategies identified as being associated with shorter DTN times and further refined after pilot testing. Categorical responses are reported as frequencies. Results: Hospitals participating in the survey were 50% academic, median 163 (IQR 106-247) ischemic stroke admissions per year, median 10 (IQR 6-17) tPA treated patients per year, and had median 79 minute (IQR 71-89) DTN times. By survey, 214 of 304 hospitals (70%) reported initiating or revising strategies to reduce DTN times in the prior 2 years. Reported use of the different strategies varied in frequency, with use of ischemic stroke critical pathways, CT scanner located in the Emergency Department, and tPA being stored in the Emergency Department being the strategies least frequently employed (Table). As part of Target: Stroke participation, 279 of 304 hospitals (91.5%) indicated they planned to have a dedicated team focused on reducing DTN times. Conclusions: While most US hospitals participating in this survey report use of the strategies to improve the timeliness of tPA administration for acute ischemic stroke, significant variation exists. Further research is needed to understand which of these strategies are most effective in improving acute ischemic stroke care.

Abstract P260: Mind the Time: A Quality Improvement Project to Increase the Percent of Ischemic Stroke Patients Receiving Intravenous Tissue Plasminogen Activator within 60 Minutes after Arrival at the Emergency Department

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Janine M Mazabob ◽  
Gerard Brown ◽  
Sarah Livesay ◽  
Sue Freeborg ◽  
Jose Suarez ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Process Model ◽  
Early Recognition ◽  
Stroke Patients ◽  
Improvement Project ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Background and Purpose: Stroke is the third leading cause of death and leading cause of long term disability in the USA. Intravenous administration of tissue plasminogen activator (t-PA) is the only FDA approved medical therapy for treatment of patients with acute ischemic stroke. It is recommended by the American Heart Association that earlier treatment with t-PA within 90 minutes of symptoms may result in a more favorable patient outcome. Initiating t-PA for ischemic stroke patients within 60 minutes after Emergency Department (ED) triage is an indicator tracked by the Get With The Guidelines database. The purpose of our project was to increase the number of ischemic stroke patients receiving t-PA within 60 minutes after triage. Methods: The Six Sigma® process model was applied in order to develop an understanding of variations in the times of triage to initiation of IV t-PA data. We assembled a multidisciplinary team to develop and measure aspects of our current protocols, analyze data, investigate and identify the causes of delays and form action plans to enhance our new process. We tracked the patient flow from first responder contact to thrombolysis time. As a result the team acknowledged that it was imperative to impact the early recognition of ischemic stroke patients in the field. This led to local and regional stroke educational programs. Our neuroscience team of physicians and nurses proceeded to educate over 850 emergency responders. Results: Initial analysis of the baseline data showed that 56 % (5 of 9) of the ischemic stroke patients received intravenous t-PA within 60 minutes of triage. Once the stroke code process was implemented, 79 % (15 of 19) of ischemic stroke patients received intravenous t-PA within 60 minutes after triage. These results were obtained within 9 months of process implementation. Specific process changes included the use of a standard time clock, shorter CT scan turn around times, dedicated 24/7 ED pharmacists, quicker availability of medication administration pumps and ongoing feedback by all team members on the acute stroke process. Conclusions: The stroke team was able to identify barriers, institute process changes and ensure the implementation of change from the prehospital community setting to the acute inhospital care.

scholarly journals Frequency of stroke patients qualified for recombinant tissue plasminogen activator (r-TPA) and constraints in Zahedan 2016

2017 ◽  
Vol 7 (1) ◽  
pp. 7 ◽  
Author(s):  
Alireza Khosravi ◽  
Mohammad-taghi Farzadfard ◽  
Arezoo Abdollahpour
Keyword(s):  
Ischemic Stroke ◽  
Ct Scan ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Demographic Data ◽  
Recombinant Tissue Plasminogen Activator ◽  
City Hospital ◽  
Stroke Patients ◽  
Tissue Plasminogen ◽  
To Receive

Background: Brain stroke is one of the common causes of mortality and disability. By introducing r-TPA into the global drug market and its effect on the patients’ prognosis, using this drug is recommended in all patients with ischemic stroke who visited less than 4.5 hours after start stroke symptoms. The aim of this study was to investigate the frequency of stroke patients qualified for recombinant tissue plasminogen activator (r-TPA) and its constraints.Methods: In this descriptive cross-sectional study, 244 patients examined with stroke admitted to the neurology of Zahedan city hospital in 2016. Information form were completed with demographic data, transmission method, referral time, CT scan preparation time, and the response of the patients' trials, and finally the data were inserted in SPSS.16 software and analysed by statistical methods.Results: Out of all patients with ischemic stroke, 28 (11.5%) patients had contraindication to receive drug. Of 216 remain patients, 201 patients (93.1%) had no possibility to receive r-TPA due to the loss of gold time and only 15 patients (6.9%) had possibility to receive drug because of visited 4.5 hours before the beginning of symptoms. Of them, 3(20%) patients due to delay in CT scan and test results, had no possibility to receive r-TPA. In summary, of all patients with inclusion criteria, only 12 (5.5%) patients could use the r-TPA in this study.Conclusions: The most important barrier to using r-TPA has been the loss of golden time and training to raise awareness of the society can lead to early referral from the onset of stroke symptoms.

Abstract WP242: A Drill Down Analysis of Door-to-Needle Time of Acute Ischemic Stroke Patients Treated with Intravenous Tissue Plasminogen Activator

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Marija Lum ◽  
Jon Schrock
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Symptom Onset ◽  
Demographic Data ◽  
Head Ct ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background: Target stroke guidelines recommend a door-to-needle time (DNT) ≤60 minutes for acute ischemic stroke (AIS) patients treated with tissue plasminogen activator (tPA). Research has shown that <30% of patients achieve this goal. It is unclear how the timing of chest radiography (CXR) and electrocardiography (EKG) affect DNT. We studied all steps involved in the evaluation and treatment of AIS with IV tPA to look for causes of delay. Methods: A retrospective review of all AIS patients treated in the ED with IV tPA over a four year period was performed. Transferred patients were excluded. Times comparing intervals from door to head CT, CT result, EKG, CXR, and IV tPA treatment, were evaluated. Demographic data and length of symptom onset were recorded. Non-modifiable delays in treatment were recorded. Data are presented in minutes (min) as medians with interquartile range and χ 2 testing was used as appropriate. Results: A total of 79 AIS patients met inclusion criteria, with 22 (28%) receiving IV tPA ≤60 minutes. Treatment with tPA in ≤60 minutes was significantly greater if symptom onset was >90 minutes (p<0.05) and if the EKG was done after the head CT (p<0.05). There was a change in median CT times with those who received EKG before CT and those who did not, 23 min (15-36 min) and 17 min (10-24min), respectively. Patients who received a CXR before CT had a median CT time of 32 min (21-38min) compared to 19 min (13-27min) for patients who did not. Unavoidable delays related to trauma, intubation, or delayed familial consent occurred in 7 (9%) patients. Post-tPA hemorrhage occurred in 13 (16%) patients. Eight (10%) patients expired. Conclusion: Non-critical studies performed prior to head CT increase DNT. An EKG performed before the head CT is completed increased CT time by 6 minutes and a CXR obtained before the head CT increased CT time by 13 minutes. Physician urgency is also a critical factor in DNT and is diminished in patients who arrive soon after symptom onset. DNT ≤60 minutes for AIS patients are affected by the level of urgency and order of diagnostic studies. Current primary stroke center recommendations of an EKG and CXR within 45 minutes may result in delayed treatment if these studies are performed before the head CT.

Pharmacist Participation in Acute Ischemic Stroke Decreases Door-to-Needle Time to Recombinant Tissue Plasminogen Activator

2017 ◽  
Vol 51 (12) ◽  
pp. 1084-1089 ◽  
Author(s):  
Megan A. Rech ◽  
Stephanie Bennett ◽  
Elisabeth Donahey
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Recombinant Tissue Plasminogen Activator ◽  
Exclusion Criteria ◽  
Stroke Team ◽  
Tissue Plasminogen ◽  
Response Team

Background: Pharmacists are an important member of the stroke team and aid in obtaining medication and medical history, providing education, managing blood pressure, reviewing exclusion criteria for recombinant tissue plasminogen activator (rtPA), and facilitating reconstitution and administration of rtPA. Objective: To determine if pharmacist presence at bedside during acute ischemic stroke resulted in a reduction in door-to-needle (DTN) times. Methods: This was a retrospective cohort study between January 1, 2011 and December 31, 2015 of patients who received rtPA for acute ischemic stroke in either the emergency department or hospital. Results: Of the 125 included patients, 45 patients (36%) had a pharmacist present (PharmD group) and 80 patients (64%) did not (no PharmD group). Median DTN time was significantly shorter in the PharmD group: 48 minutes versus 73 minutes in the no PharmD group ( P < 0.01). The goal of DTN ≤60 minutes was met in 71% of patients in the PharmD group compared to 29% ( P < 0.01). Pharmacist at the bedside was the only factor found to be independently associated with reduction DTN time (βcoefficient −23.5 minutes, 95% confidence interval [95% CI] −38.6 to −8.50 minutes). Conclusion: A pharmacist at the bedside of emergency department or in-patient stroke codes reduced DTN time by a median of 23.5 minutes after adjusting for confounding factors and increased the percentage of patients meeting DTN goal time of ≤60 minutes by 49%. These findings support the inclusion of a stroke-competent pharmacist in the bedside response team for acute ischemic stroke patients.

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