Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience.
JAMA
; 283(9): 1151-8, 2000 Mar 01.
Article
em En
| MEDLINE
| ID: mdl-10703777
ABSTRACT
CONTEXT Little is known regarding outcomes after intravenous tissue-type plasminogen activator (IV tPA) therapy for acute ischemic stroke outside a trial setting. OBJECTIVE:
To assess the rate of IV tPA use, the incidence of symptomatic intracerebral hemorrhage (ICH), and in-hospital patient outcomes throughout a large urban community.DESIGN:
Historical prospective cohort study conducted from July 1997 through June 1998.SETTING:
Twenty-nine hospitals in the Cleveland, Ohio, metropolitan area. PATIENTS A total of 3948 patients admitted to a study hospital with a primary diagnosis of ischemic stroke (International Classification of Diseases, Ninth Revision, Clinical Modification code 434 or 436). MAIN OUTCOMEMEASURES:
Rate of IV tPA use and occurrence of symptomatic ICH among patients treated with tPA; proportion of patients receiving tPA whose treatment deviated from national guidelines; in-hospital mortality among patients receiving tPA compared with that among ischemic stroke patients not receiving tPA and with mortality predicted by a model.RESULTS:
Seventy patients (1.8%) admitted with ischemic stroke received IV tPA. Of those, 11 patients (15.7%; 95% confidence interval [CI], 8.1%-26.4%) had a symptomatic ICH (of which 6 were fatal) and 50% (95% CI, 37.8%-62.2%) had deviations from national treatment guidelines. In-hospital mortality was significantly higher among patients treated with tPA (15.7%) compared with patients not receiving tPA (5.1%, P<.001) and compared with the model's prediction (7.9%; P<.006).CONCLUSIONS:
A small proportion of patients admitted with acute ischemic stroke in Cleveland received tPA; they experienced a high rate of ICH. Cleveland community experience with tPA for acute ischemic stroke may differ from that reported in clinical trials.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ativadores de Plasminogênio
/
Terapia Trombolítica
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Ativador de Plasminogênio Tecidual
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Acidente Vascular Cerebral
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
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Humans
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Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
JAMA
Ano de publicação:
2000
Tipo de documento:
Article
País de afiliação:
Estados Unidos