Treatment with intravenous trombolysis out of stroke center

Czech version

Authors: M. Hořejší ¹; J. Machová ²; F. Pfeifer ³; T. Růžičková ¹; A. Tomek ¹; M. Šrámek ^1,4
Authors‘ workplace: Neurologická klinika, 2. LF UK a FN Motol, Praha ¹; Neurologické oddělení, Nemocnice Hořovice ²; Neurologické oddělení, Nemocnice Jindřichův Hradec ³; Neurologické oddělení, ÚVN – VFN, Praha ⁴
Published in: Cesk Slov Neurol N 2020; 83/116(5): 555-558
Category: Short Communication
doi: https://doi.org/10.14735/amcsnn2020555

Overview

Aim: The study objective was to evaluate the safety and effectiveness of intravenous thrombolysis (IVT) in patients with ischemic stroke treated at the neurological department that is not the certified stroke center in the Czech Republic.

Materials and methods: A retrospective multicentric analysis of patients with ischemic stroke who meet the IVT indication guidelines and who were treated during 2016 and 2017 at the Departments of Neurology in Hořovice Hospital and Jindřichův Hradec Hospital. The analysis comprehended demographic and anamnestic data, way and cause of transport to the hospital and reasons for not using primary transport to a certified stroke centre. The logistics and efficiency of IVT treatment were evaluated by standard time and clinical indicators.

Results: In total 100 patients (63 Hořovice, 37 Jindřichův Hradec) were included. A significant portion of patients came on their own (28%), or they suffered from ischemic stroke during hospitalization for other diagnoses (11%), in 21% of patients stroke symptoms were not recognized by emergency medical service (EMS). There were no significant differences in basic demographic data (age, gender, National Institutes of Health Stroke Scale [NIHSS] on arrival) between the two compared departments. In comparison with national data from certified stroke centers, the NIHSS on arrival was lower (5.54 vs. 9.48 points), there was no significant difference in intra-cerebral hemorrhage complications (9 vs. 7%), as well as mortality rate (13 vs. 15%).

Conclusion: The system of the certified national stroke center is the base of care for patients with stroke. Nevertheless, the IVT treatment may begin safely and effectively also at the other neurological department. There will still be a certain portion of patients with acute ischemic stroke who come primarily to the standard neurological department despite the well functioning network of stroke centers and EMS.

Keywords:

ischemic stroke – intravenous thrombolysis – certifi ed stroke centers for patient with acute stroke

Sources

1. Data Cerebrovaskulární sekce ČNS ČLS JEP z registrůSITS a RES-Q. [online]. Dostupné z URL: cmp.cz, qualityregistry.eu, sitsinternational.org.

2. Věstník Ministerstva zdravotnictví číslo 2/2010. [online]. Dostupné z URL: https: //www.mzcr.cz/wp-content/uploads/wepub/3703/36342/V%C4%9Bstn%C3%ADk%20MZ%20%C4%8CR%202-2010.pdf.

3. Věstník ministerstva zdravotnictví číslo 11/2015. [online]. Dostupné z URL: http: //staryweb.mzcr.cz/Legislativa/dokumenty/vestnik-c11/2015_10551_3242_11.html.

4. Česká neurologická společnost. Adresář lůžkových neurologických zařízení. [online]. Dostupné z URL: https: //www.czech-neuro.cz/content/uploads/2018/04/2018-neurologicka-luzkova-zarizeni.xls.

5. Neumann J, Tomek A, Školoudík D et al. Doporučený postup pro intravenózní trombolýzu v léčbě mozkového infarktu – verze 2014. Cesk Slov Neurol N 2014; 77/110 (3): 381–385.

6. Šaňák D, Neumann J, Tomek A et al. Doporučený postup pro rekanalizační léčbu akutního mozkového infarktu – verze 2016. Cesk Slov Neurol N 2016; 79/112 (2): 231–234. doi: 10.14735/amcsnn2016231.

7. The NINDS t-PA Stroke Study Group. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke; 28 (11): 2109–2118. doi: 10.1161/01.str.28.11.2109.