Intravenous recombinant tissue plasminogen activator (rt-PA) was approved in 2003 for the treatment of ischaemic stroke within 3 hours of onset. However, it is rarely used in community hospitals. It therefore remains questionable whether the studies reporting the experience from specialized centers are relevant to community hospitals in which stroke management tends to be more conservative.
This paper reports the results of an observational cohort study that included 39 patients treated with intravenous rt-PA according to the NINDS rtPA protocol at the St Jean Hospital in Perpignan, France between March 1, 2002 and August 31, 2005. The results are compared to those of the treatment arm of the NINDS study.
1.2 per cent of ischaemic strokes were treated with intravenous rt-PA.The outcomes are similar to those of the NINDS study and favourable with a modified Rankin score (mRS) of 0 or 1 in 44 per cent of patients compared to 39 per cent in the NINDS study (Chi2 = 0.34; p = 0.5). There were no significant differences in terms of death or outcome at 3 months, also assessed with the mRS (Chi2 = 0.09; p = 0.75 and Chi2 = 0.77; p = 0.75 respectively). No symptomatic haemorrhagic transformation was observed related to rt-PA use.
Based on these results the study concludes that rt-PA therapy for ischaemic stroke may be as safe and effective in a community hospital setting as it appears to be in the context of specialised stroke centres.
© 2006 Elsevier Masson SAS. Tous droits réservés.