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Clinical Trial
. 2012 Jun;43(6):1591-5.
doi: 10.1161/STROKEAHA.111.645986. Epub 2012 Mar 22.

Eligibility for Intravenous Recombinant Tissue-Type Plasminogen Activator Within a Population: The Effect of the European Cooperative Acute Stroke Study (ECASS) III Trial

Felipe de Los Ríos la Rosa  1 , Jane Khoury, Brett M Kissela, Matthew L Flaherty, Kathleen Alwell, Charles J Moomaw, Pooja Khatri, Opeolu Adeoye, Daniel Woo, Simona Ferioli, Dawn O Kleindorfer
Affiliations
Clinical Trial

Eligibility for Intravenous Recombinant Tissue-Type Plasminogen Activator Within a Population: The Effect of the European Cooperative Acute Stroke Study (ECASS) III Trial

Felipe de Los Ríos la Rosa et al. Stroke. 2012 Jun.

Abstract

Background and purpose: The publication of the European Cooperative Acute Stroke Study (ECASS III) expanded the treatment time to thrombolysis for acute ischemic stroke from 3 to 4.5 hours from symptom onset. The impact of the expanded time window on treatment rates has not been comprehensively evaluated in a population-based study.

Methods: All patients with an ischemic stroke presenting to an emergency department during calendar year 2005 in the 17 hospitals that compromise the large 1.3 million Greater Cincinnati/Northern Kentucky population were included in the analysis. Criteria for exclusion from thrombolytic therapy are analyzed retrospectively for both the standard and expanded timeframes with varying door-to-needle times.

Results: During the study period, 1838 ischemic strokes presenting to an emergency department were identified. A small proportion of them arrived in the expanded time window (3.4%) compared with the standard time window (22%). Only 0.5% of those who arrived in this timeframe met eligibility criteria for thrombolysis compared with 5.9% using standard eligibility criteria in the standard timeframe. These results did not vary significantly by repeated analysis varying the door-to-needle time or the expanded time window's exclusion criteria.

Conclusions: In reality, the expanded time window for thrombolysis in acute ischemic stroke benefits few patients. If we are to improve recombinant tissue-type plasminogen activator administration rates, our focus should be on improving stroke awareness, transport to facilities with ability to administer thrombolysis, and familiarity of physicians with acute stroke treatment guidelines.

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Conflict of interest statement

Conflict of interests / disclosures

The following authors receive research support from the NIH: P. Khatri, D. Kleindorfer, O. Adeoye, B.M. Kissela, K. Alwell, C.J. Moomaw, and J.C. Khoury.

Dr. Pooja Khatri receives research support and travel support as an unpaid consultant from Genentech, also receives research support from Penumbra as PI of THERAPY Trial.

Dr. Kleindorfer and Dr. Adeoye are members of the speaker’s bureau, Genentech.

Dr. Kissela receives research support from Nexstium, he also receives honoraria from Allergan and Reata pharmaceuticals.

Dr. Flaherty receives honoraria from Boehringer – Ingelheim.

Figures

Figure 1
Figure 1
Eligibility for rT- PA and hospital arrival times. Data presented as raw n (weighted % of the 1838 strokes).
See this image and copyright information in PMC

References

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