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05.10.2018

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

Zeitschrift:
Journal of Thrombosis and Thrombolysis
Autoren:
Stefano Forlivesi, Manuel Cappellari, Claudio Baracchini, Federica Viaro, Adriana Critelli, Carmine Tamborino, Simone Tonello, Silvia Vittoria Guidoni, Martina Bruno, Silvia Favaretto, Alessandro Burlina, Emanuele Turinese, Franco Ferracci, Sandro Zambito Marsala, Salvatrice Bazzano, Federica Orlando, Michelangelo Turazzini, Silvia Ricci, Morena Cadaldini, Floriana De Biasia, Sandro Bruno, Anna Gaudenzi, Michele Morra, Alessandra Danese, Roberto L’Erario, Monia Russo, Giampietro Zanette, Domenico Idone, Anna Maria Basile, Matteo Atzori, Maela Masato, Elisabetta Menegazzo, Francesco Paladin, Agnese Tonon, Giorgio Caneve, Giulio Bozzato, Alessandro Campagnaro, Simona Carella, Piero Nicolao, Roberta Padoan, Francesco Perini, Antonella De Boni, Alessandro Adami, Bruno Bonetti, Paolo Bovi

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.

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