Use of Tissue-Type Plasminogen Activator for Acute Ischemic Stroke

作者：Irene Katzan, Anthony J. Furlan, Lynne E. Lloyd, Jeffrey I. Frank, Dwain L. Harper, Judith A. Hinchey, Jeffrey Hammel, Annie Qu, Cathy Sila · 发表于：JAMA · 年份：2000 · DOI：10.1001/jama.283.9.1151 · 被引用次数：659 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Protease and Inhibitor Mechanisms

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 OUTCOME MEASURES: 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 ...