Eligibility for Intravenous Recombinant Tissue-Type Plasminogen Activator Within a Population: The Effect of the European Cooperative Acute Stroke Study (ECASS) III Trial.
Eligibility for Intravenous Recombinant Tissue-Type Plasminogen Activator Within a Population: The Effect of the European Cooperative Acute Stroke Study (ECASS) III Trial.
复制标题
DOI：
10.1161/strokeaha.111.645986
复制
发表时间：
2012-06
期刊：
影响因子：
8.3
通讯作者：
Kleindorfer DO
中科院分区：
文献类型：
--
作者：
de Los Ríos la Rosa F;Khoury J;Kissela BM;Flaherty ML;Alwell K;Moomaw CJ;Khatri P;Adeoye O;Woo D;Ferioli S;Kleindorfer DO
欧洲急性卒中合作研究（ECASS III）的发表将急性缺血性卒中的溶栓治疗时间从症状发作后3小时延长至4.5小时。尚未在基于人群的研究中全面评价扩展时间窗对治疗率的影响。2005日历年期间，在17家医院（涉及大辛辛那提/北方肯塔基州的130万人口）就诊于急诊科（艾德）的所有缺血性卒中患者均纳入分析。回顾性分析了标准和扩展时间范围内从溶栓治疗中排除的标准，不同的门到针的时间。在研究期间，确定了1838例到艾德就诊的缺血性卒中。与标准时间窗（22%）相比，他们中的一小部分人（3.4%）在扩大的时间窗内到达。在这一时间范围内到达的患者中，只有0.5%符合溶栓的资格标准，而在标准时间范围内使用标准资格标准的患者为5.9%。这些结果在重复分析中没有显著差异，这些分析改变了门到针的时间或扩展时间窗的排除标准。实际上，急性缺血性卒中溶栓时间窗延长后，受益患者很少。如果我们要提高rT-PA给药率，我们的重点应该是提高卒中意识，运送到有能力进行溶栓治疗的机构，以及医生对急性卒中治疗指南的熟悉程度。
The publication of the European Cooperative Acute Stroke Study (ECASS III) expanded the treatment time to thrombolysis for acute ischemic stroke from 3 to 4.5 hours from symptom onset. The impact of the expanded time window on treatment rates has not been comprehensively evaluated in a population based study. All patients suffering from an ischemic stroke presenting to an emergency department (ED) during calendar year 2005 in the 17 hospitals that compromise the large 1.3 million Greater Cincinnati / Northern Kentucky population were included in the analysis. Criteria for exclusion from thrombolytic therapy are analyzed retrospectively for both the standard and expanded time frames with varying door to needle times. During the study period 1838 ischemic strokes presenting to an ED were identified. A small proportion of them arrived in the expanded time window (3.4%) compared to the standard time window (22%). Only 0.5% of those who arrived in this time frame met eligibility criteria for thrombolysis, compared to 5.9% using standard eligibility criteria in the standard timeframe. These results did not vary significantly by repeated analysis varying the door to needle time or the expanded time window’s exclusion criteria. In reality, the expanded time window for thrombolysis in acute ischemic stroke benefits few patients. If we are to improve rT-PA administration rates our focus should be on improving stroke awareness, transport to facilities with ability to administer thrombolysis, and familiarity of physicians with acute stroke treatment guidelines.