Understanding the reasons behind the low utilisation of thrombolysis in stroke

Eissa, A; Krass, I; Levi, C; Sturm, J; Ibrahim, R; Bajorek, B

Understanding the reasons behind the low utilisation of thrombolysis in stroke

Eissa, A Krass, I Levi, C Sturm, J Ibrahim, R Bajorek, B

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Publication Type:: Journal Article
Citation:: Australasian Medical Journal, 2013, 6 (3), pp. 152 - 163
Issue Date:: 2013-04-05

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Field	Value	Language
dc.contributor.author	Eissa, A	en_US
dc.contributor.author	Krass, I	en_US
dc.contributor.author	Levi, C	en_US
dc.contributor.author	Sturm, J	en_US
dc.contributor.author	Ibrahim, R	en_US
dc.contributor.author	Bajorek, B https://orcid.org/0000-0002-2532-7187	en_US
dc.date.issued	2013-04-05	en_US
dc.identifier.citation	Australasian Medical Journal, 2013, 6 (3), pp. 152 - 163	en_US
dc.identifier.issn	1836-1935	en_US
dc.identifier.uri	http://hdl.handle.net/10453/28511
dc.description.abstract	Background Thrombolysis remains the only approved therapy for acute ischaemic stroke (AIS); however, its utilisation is reported to be low. Aims This study aimed to determine the reasons for the low utilisation of thrombolysis in clinical practice. Method Five metropolitan hospitals comprising two tertiary referral centres and three district hospitals conducted a retrospective, cross-sectional study. Researchers identified patients discharged with a principal diagnosis of AIS over a 12-month time period (July 2009-July 2010), and reviewed the medical record of systematically chosen samples. Results The research team reviewed a total of 521 records (48.8% females, mean age 74.4 ±14 years, age range 5-102 years) from the 1261 AIS patients. Sixty-nine per cent of AIS patients failed to meet eligibility criteria to receive thrombolysis because individuals arrived at the hospital later than 4.5 hours after the onset of symptoms. The factors found to be positively associated with late arrival included confusion at onset, absence of a witness at onset and waiting for improvement of symptoms. However, factors negatively associated with late arrival encompassed facial droop, slurred speech and immediately calling an ambulance. Only 14.7% of the patients arriving within 4.5 hours received thrombolysis. The main reasons for exclusion included such factors as rapidly improving symptoms (28.2%), minor symptoms (17.2%), patient receiving therapeutic anticoagulation (6.7%) and severe stroke (5.5%). Conclusion A late patient presentation represents the most significant barrier to utilising thrombolysis in the acute stroke setting. Thrombolysis continues to be currently underutilised in potentially eligible patients, and additional research is needed to identify more precise criteria for selecting patients for thrombolysis.	en_US
dc.relation.ispartof	Australasian Medical Journal	en_US
dc.relation.isbasedon	10.4066/AMJ.2013.1607	en_US
dc.title	Understanding the reasons behind the low utilisation of thrombolysis in stroke	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	6	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
utslib.copyright.status	open_access
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	6	en_US

Abstract:

Background Thrombolysis remains the only approved therapy for acute ischaemic stroke (AIS); however, its utilisation is reported to be low. Aims This study aimed to determine the reasons for the low utilisation of thrombolysis in clinical practice. Method Five metropolitan hospitals comprising two tertiary referral centres and three district hospitals conducted a retrospective, cross-sectional study. Researchers identified patients discharged with a principal diagnosis of AIS over a 12-month time period (July 2009-July 2010), and reviewed the medical record of systematically chosen samples. Results The research team reviewed a total of 521 records (48.8% females, mean age 74.4 ±14 years, age range 5-102 years) from the 1261 AIS patients. Sixty-nine per cent of AIS patients failed to meet eligibility criteria to receive thrombolysis because individuals arrived at the hospital later than 4.5 hours after the onset of symptoms. The factors found to be positively associated with late arrival included confusion at onset, absence of a witness at onset and waiting for improvement of symptoms. However, factors negatively associated with late arrival encompassed facial droop, slurred speech and immediately calling an ambulance. Only 14.7% of the patients arriving within 4.5 hours received thrombolysis. The main reasons for exclusion included such factors as rapidly improving symptoms (28.2%), minor symptoms (17.2%), patient receiving therapeutic anticoagulation (6.7%) and severe stroke (5.5%). Conclusion A late patient presentation represents the most significant barrier to utilising thrombolysis in the acute stroke setting. Thrombolysis continues to be currently underutilised in potentially eligible patients, and additional research is needed to identify more precise criteria for selecting patients for thrombolysis.

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http://hdl.handle.net/10453/28511