In acute ischemic stroke
More eligible patients could benefit through improved patient selection and protocol adherence1

Could 16.2% more patients arriving within 3 hours of symptom onset receive Activase (t-PA)?

Activase (t-PA) treatment begins with proper patient selection

  • Despite the proven benefits of Activase (t-PA), one survey found that only about 27% of patients arriving within 3 hours of symptom onset received treatment1
    • – Various other studies show that 72% to 87% of eligible patients may go untreated1-3
  • Major reasons why patients who arrived within the 3-hour window were excluded from treatment1:
    • – Clinical improvement (18.2%)
    • – Symptoms too mild (13.1%)
  • Documentation of onset times and eligibility is also critical2

Stroke centers increase treatment and improve patient outcomes4-7

Activase (t-PA) administration of Surburban Hospital before and after establishment of a stroke center

Reducing pre- and in-hospital response times and using appropriate resources improve Activase (t-PA) administration2

A study of primary stroke center recommendations found 7 criteria associated with Activase (t-PA) use7*:

  • Continuing medical education†
  • Written care protocols†
  • Organized emergency department†
  • Integrated emergency medical services†
  • Neuroimaging services
  • Stroke unit
  • Acute stroke teams
  • *
  • Brain Attack Coalition criteria and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommendations.
  • †
  • Associated with significantly increased Activase (t-PA) use.

Indication: Activase is indicated for the management of acute ischemic stroke in adults for improving neurological recovery and reducing the incidence of disability. Treatment should only be initiated within 3 hours after the onset of stroke symptoms, and after exclusion of intracranial hemorrhage by a cranial computerized tomography (CT) scan or other diagnostic imaging method sensitive for the presence of hemorrhage (see CONTRAINDICATIONS in the full prescribing information).

Safety Information: All thrombolytic agents increase the risk of bleeding, including intracranial bleeding, and should be used only in appropriate patients. Not all patients with acute ischemic stroke will be eligible for Activase therapy, including patients with evidence of recent or active bleeding; recent (within 3 months) intracranial or intraspinal surgery, serious head trauma, or previous stroke; uncontrolled high blood pressure; or impaired blood clotting.


Please see full prescribing information.


References:
1.
Barber PA, Zhang J, Demchuk AM, Hill MD, Buchan AM. Why are stroke patients excluded from TPA therapy? Neurology. 2001;56:1015-1020.
2.
Deng YZ, Reeves MJ, Jacobs BS, et al. IV tissue plasminogen activator use in acute stroke. Neurology. 2006;66:306-312.
3.
Cocho D, Belvís R, Martí-Fàbregas J, et al. Reasons for exclusion from thrombolytic therapy following acute ischemic stroke. Neurology. 2005;64:719-720.
4.
Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke. Stroke. 2007;38:1655-1711.
5.
Katzan IL, Hammer MD, Furlan AJ, Hixson ED, Nadzam DM, on behalf of the Cleveland Clinic Health System Stroke Quality Improvement Team. Quality improvement and tissue-type plasminogen activator for acute ischemic stroke: a Cleveland update. Stroke. 2003;34:799-800.
6.
Lattimore SU, Chalela J, Davis L, et al. Impact of establishing a primary stroke center at a community hospital on the use of thrombolytic therapy: the NINDS suburban hospital stroke center experience. Stroke. 2003;34:e55-e57.
7.
Douglas VC, Tong DC, Gillum LA, et al. Do the Brain Attack Coalition's criteria for stroke centers improve care for ischemic stroke? Neurology. 2005;64:422-427.
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