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J Formos Med Assoc. 2014 Dec;113(12):929-33. doi: 10.1016/j.jfma.2013.11.012. Epub 2014 Jan 10.

Efforts to reduce the door-to-needle time of thrombolysis in acute ischemic stroke: video-assisted therapeutic risk communication.

Author information

1
Stroke Center and Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan; Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University Hospital, Tainan, Taiwan.
2
Stroke Center and Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.
3
Stroke Center and Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan.
4
Department of Emergency Medicine, Tainan Sin Lau Hospital, Tainan, Taiwan.
5
Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University Hospital, Tainan, Taiwan.
6
Stroke Center and Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan. Electronic address: tschern@gmail.com.

Abstract

BACKGROUND/PURPOSE:

Explaining the risks and benefits of recombinant tissue-plasminogen activator (rtPA) to eligible patients with acute ischemic stroke (AIS) within a few minutes is important but difficult. We examined whether a new thrombolysis program can decrease the door-to-needle (DTN) time when treating patients with AIS.

METHODS:

A new rtPA thrombolysis program with video assistance was adapted for patients with AIS and their families. We retrospectively compared outcome quality before (2009-2011) and after (2012) the program began. Outcomes included DTN time, the percentage of rtPA thrombolysis within 3 hours of onset in all hospitalized patients with AIS who presented within 2 hours of onset (2 hr%) and the percentage of rtPA thrombolysis in all hospitalized patients with AIS (AIS%).

RESULTS:

We recruited patients with AIS who had undergone thrombolytic therapy before (n = 18) and after (n = 14) the initiation of the new program. DTN time decreased (93 ± 24 minutes to 57 ± 14 minutes, p < 0.001) and the AIS% increased (2% to 5%, p = 0.010) after the program. The 2 hr% marginally significantly increased (18% to 33%, p = 0.080).

CONCLUSION:

A thrombolysis program with video-assisted therapeutic risk communication decreased DTN time and increased the treatment rate of patients with AIS.

KEYWORDS:

cerebral infarction; emergency medicine; plasminogen activators; thrombolytic therapy

PMID:
24412584
DOI:
10.1016/j.jfma.2013.11.012
[Indexed for MEDLINE]
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