Treating acute stroke patients with intravenous tPA - The OSF Stroke Network experience

Background and Purpose-Since the FDA approved tissue plasminogen activator (tPA) in 1996 for acute ischemic stroke, few data have been obtained during the postmarketing phase, and applicability in rural hospitals does not exist. We attempt to examine the safety and outcome of intravenous tPA for acute ischemic stroke in the OSF Stroke Network. Methods-Fifty-seven consecutive patients treated with tPA were examined from June 1996 through December 1998. Admission and discharge National Institute of Health Stroke Scales (NIHSS), modified Rankin Scales (MRS), and discharge disposition, as well as intracerebral hemorrhage and mortality rates, were compared. Results-Of 20 network hospitals, 12 had the experience of administering tPA. No statistically significant differences in the variables recorded were observed for patients treated at the community hospitals versus those who received tPA at the tertiary medical center. In 35% of patients, tPA was initiated by an emergency room or primary care physician in consultation with an OSF neurologist. At discharge, 47% of the patients had minimal or no disability (MRS, 0 to 1), 44% had an NIHSS score of 0 or 1, 54% went home, 25% were transferred to in-patient rehabilitation, 12% went to a nursing or skilled-care facility, and 9% died. Intracerebral hemorrhage rate was 9%; 5% were symptomatic. Conclusions-tPA can be administered safely with good outcome at community and rural hospitals. The OSF Stroke Network can serve as a model to assist small community hospitals to set up stroke programs and deliver up-to-date, acute stroke therapies.