Intravenous Thrombolysis for Acute Ischemic Stroke in a High Complex Regional Hospital

Abstract

Background : Intravenous thrombolysis (IVT) with alteplase (tissue plasminogen activa- tor) is the standard pharmacological treatment in acute ischemic stroke (AIS), reducing disability in patients. Aim : To report the results of a thrombolysis protocol taken during 6 years in a regional public hospital at Temuco, Chile. Material and methods : Data from 231 consecutive patients aged 67.1 ± 13.1 years (58.9% men) who were treated with IVT, from May 2012 until April 2018, were analyzed. Results: The median door-to-needle time was 71 min (interquartile range = 53–102). The median National Institute of Health Stroke Scale (NIHSS) scores on admission and at discharge were 13 and 4 points, respectively. At discharge, 27% of hospitalized patients had a favorable outcome, defined as having 0 to 1 points in the modified Rankin scale. Symptomatic intracerebral hemorrhage and mortality rates were 5.7 and 13.1%, respec- tively. The thrombolysis rate rose from 0.7% in 2012 to 5.5% in 2018. Conclusions: The implementation of 24/7 neurology shifts in the Emergency Department allowed us to increase the amount and quality of IVT in our hospital, as measured by the rate of thrombolysis and by process indicators such as door-to-needle