INTRAVENOUS TISSUE-PLASMINOGEN ACTIVATOR FOR ACUTE ISCHEMIC STROKE - FEASIBILITY, SAFETY, AND EFFICACY IN THE FIRST YEAR OF CLINICAL-PRACTICE

Background and Purpose-The feasibility, safety, and efficacy of intrav enous tissue plasminogen activator (t-PA) for patients with acute isch emic stroke in clinical practice need to be assessed. Methods-We initi ated a prospective open-label study at a university hospital and two c ommunity hospitals in Houston, Tex, immediately after the publication of the National Institute of Neurological Disorders and Stroke (NINDS) t-PA study. A total of 30 patients, age 32 to 90 years, were treated with 0.9 mg/kg of intravenous t-PA (maximum dose, 90 mg) within 3 hour s of acute ischemic stroke between December 1995 and December 1996. Re sults-Six percent (6%) of all patients hospitalized with ischemic stro ke received intravenous t-PA at the university hospital and 1.1% at th e community hospitals, The rates of total, symptomatic, and fatal intr acerebral hemorrhage were 10%, 7%, and 3%. Thirty-seven percent (37%) of patients recovered to fully independent function. The average time from stroke onset to emergency department arrival was 57 minutes; emer gency department arrival to computed tomography scan 41 minutes; and c omputed tomography scan to administration of treatment 59 minutes. Con clusions-Wen treatment guidelines are carefully followed in an urban h ospital setting, intravenous t-PA for acute ischemic stroke is feasibl e and shows safety and efficacy comparable to the results of the NINDS study.