Mild Stroke and Advanced Age Are the Major Reasons for Exclusion from Thrombolysis in Stroke Patients Admitted within 4.5 Hours

• Published in: Journal of stroke and cerebrovascular diseases Vol. 23; no. 6; pp. 1571 - 1576
• Main Authors: Liu, Yukai, MD, Zhao, Hongdong, MD, Zhou, Junshan, MD, Wang, Qing, MD, Chen, Zhonghui, MD, Luo, Na, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2014
• Subjects: Adult; advanced age; Age Factors; Aged; Aged, 80 and over; Brain Ischemia - diagnosis; Brain Ischemia - drug therapy; Cardiovascular; Databases, Factual; Female; Fibrinolytic Agents - therapeutic use; Humans; ischemic stroke; Male; Middle Aged; mild stroke; Neurology; Patient Selection; Registries; Retrospective Studies; Severity of Illness Index; Stroke - diagnosis; Stroke - drug therapy; Thrombolysis; Thrombolytic Therapy; Time Factors; Tissue Plasminogen Activator - therapeutic use; advanced age; mild stroke; Thrombolysis; ischemic stroke
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.041

Background Only 2%-3% of patients with acute ischemic stroke receive thrombolysis. The aim of this study was to identify the reasons for exclusion from thrombolysis in patients admitted within the therapeutic time window. Methods Patient data in the hospital stroke registry between January 2012 and September 2013 were retrospectively examined. All cases with a diagnosis of ischemic stroke were screened, and those admitted to the neurology wards within 4.5 hours of symptom onset were analyzed. The reasons for exclusion from thrombolysis were examined. Logistic regression analysis was used to find independent predictors of thrombolysis treatment. Results Of the 1579 cases of ischemic stroke, 234 patients were admitted to the neurology ward within 4.5 hours of symptom onset. A total of 57 patients received thrombolysis. The thrombolysis rate was 3.6% of all ischemic stroke patients. Of the 177 patients who were excluded from thrombolysis, 36.2% (n = 64) had stroke of insufficient severity to warrant thrombolysis, and 24.9% (n = 44) were older than 80 years. Logistic regression analysis showed that the interval between symptom onset and admission (odds ratio 20.24, 95% confidence interval 3.75-109.24) and history of ischemic stroke (odds ratio .11, 95% confidence interval .04-.34) affected the likelihood of thrombolysis. Conclusions Mild stroke and advanced age were the major reasons for exclusion from thrombolysis in patients admitted within 4.5 hours of symptom onset. Patients who were admitted early and those without a history of ischemic stroke were more likely to receive thrombolysis.