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J Thromb Thrombolysis. 2019 Jan;47(1):113-120. doi: 10.1007/s11239-018-1753-8.

Intravenous thrombolysis for ischemic stroke in the Veneto region: the gap between eligibility and reality.

Author information

1
Stroke Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
2
Stroke Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy. manuel_cappellari@libero.it.
3
Stroke Unit, Azienda Ospedaliera Università di Padova, Padua, Italy.
4
Stroke Unit, Ospedale dell'Angelo, Mestre, Italy.
5
Stroke Unit, Ospedale Ca' Foncello, Treviso, Italy.
6
Stroke Unit, Ospedale San Giacomo Apostolo, Castelfranco Veneto, Italy.
7
Stroke Unit, Ospedale San Bassiano, Bassano del Grappa, Italy.
8
Stroke Unit, Ospedale San Martino, Belluno, Italy.
9
Stroke Unit, Ospedale di Portogruaro, Portogruaro, Italy.
10
Stroke Unit, Ospedale Mater Salutis, Legnago, Italy.
11
Stroke Unit, Ospedali Riuniti Padova Sud Madre Teresa di Calcutta, Monselice, Italy.
12
Stroke Unit, Ospedale Santa Maria dei Battuti, Conegliano, Italy.
13
Stroke Unit, Ospedale Cazzavillan, Arzignano, Italy.
14
Stroke Unit, Ospedale Santa Maria della Misericordia, Rovigo, Italy.
15
Stroke Unit, Ospedale Pederzoli, Peschiera del Garda, Italy.
16
Stroke Unit, Ospedale Sant'Antonio, Padua, Italy.
17
Stroke Unit, Ospedale di Mirano, Mirano, Italy.
18
Stroke Unit, Ospedale Santi Giovanni e Paolo, Venice, Italy.
19
Stroke Unit, Ospedale di Cittadella, Cittadella, Italy.
20
Stroke Unit, Ospedale Alto Vicentino, Santorso, Italy.
21
Stroke Unit, Ospedale Santa Maria del Prato, Feltre, Italy.
22
Stroke Unit, Ospedale San Bortolo, Vicenza, Italy.
23
Stroke Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy.

Abstract

Intravenous thrombolysis (IVT) is the treatment of choice for most patients with acute ischemic stroke. According to the recently updated guidelines, IVT should be administered in absence of absolute exclusion criteria. We aimed to assess the proportion of ischemic strokes potentially eligible and actually treated with IVT, and to explore the reasons for not administering IVT. We prospectively collected and analyzed data from 1184 consecutive ischemic stroke patients admitted to the 22 Stroke Units (SUs) of the Veneto region from September 18th to December 10th 2017. Patients were treated with IVT according to the current Italian guidelines. For untreated patients, the reasons for not administering IVT were reported by each center in a predefined model including absolute and/or relative exclusion criteria and other possible reasons. Out of 841 (71%) patients who presented within 4.5 h of stroke onset, 704 (59%) had no other absolute exclusion criteria and were therefore potentially eligible for IVT according to the current guidelines. However, only 323 (27%) patients were eventually treated with IVT. Among 861 (73%) untreated patients, 480 had at least one absolute exclusion criterion, 283 only relative exclusion criteria, 56 only other reasons, and 42 a combination of relative exclusion criteria and other reasons. Our study showed that only 46% (323/704) of the potentially eligible patients were actually treated with IVT in the SUs of the Veneto region. All healthcare professionals involved in the acute stroke pathway should make an effort to bridge this gap between eligibility and reality.

KEYWORDS:

Eligibility; Exclusion criteria; Guidelines; Ischemic stroke; Thrombolysis

PMID:
30291514
DOI:
10.1007/s11239-018-1753-8
[Indexed for MEDLINE]

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