Thrombolysis in the Emergency Department in China: Results from an Emergency Department Registry in 7 Urban Hospitals
WANG Yi-Long;WU Di;ZHOU Yong;et al.
2009, 4(01):
23-28.
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Objective Intravenous recombinant tissue plasminogen activator(rt-PA) is the drug of choice for the treatment of acute ischemic stroke within 3 hours of onset, which has been approved for use in China but it is infrequently used. We sought to assess thrombolysis status in Chinese urban hospitals and tryto find the reasons of untreatment with rt-PA in the potential eligible patients.Methods Data from Cerebrovascular events Acute care Register Database Study(CARDs) in emergency department(ED), which was consecutively enrolled patients presented ED in 31 centers in 7 cities of China. The registry includes data on stroke patient characteristics, pre-hospital emergencycare, onset to treatment time intervals, stroke evaluation and therapy, and characteristics of patients receiving thrombolysis with rt-PA or urokinase(UK).Results A total of 1091 patients with diagnosis of stroke or Transient Ischemic Attack(TIA) were included. Of these, only 20(2.7%) of 754(69.6%) ischemic stroke patients received thrombolytic therapy (intravenous rt-PA, n=15; intra-arterial rt-PA, n=2, and intravenous UK, n=3). Protocolviolations occurred in 93.3%(14/15) of patients who received Intravenous rt-PA. Most of patients(17/20) arrived within 2 hours of symptoms onset, the onset-to-door median time was 1.17 hour,and the door-to-imaging (CT or MRI) median time was 0.67 hour. Reasons for not administeringthrombolytric therapy were age more than 80 or less than 18(28.9%), patients too mild (24.0%),rapidly improving (16.5%), CT showing lesions(15.7%), time window when stroke team assessment beyond 3h(15.7%), too severe deficit(7.4%), out of expected, no consent accounted for 18.2%.Conclusion Intravenous rt-PA was underutilized and nonstandard in this ED registry in China, and both the onset-to-door time and the imaging-to-needle time were too long. Further studies are needed to elucidate specific barriers to rt-PA use and to develop targeted quality improvement strategies.
