Knowledge and Attitudes of Saudi Emergency Physicians toward t-PA Use in Stroke (original) (raw)
Related papers
Journal of Iranian Medical Council
Background: One of the main parts of the early treatment of Acute Ischemic Stroke (AIS) is the attitude and knowledge of Emergency Medicine (EM) specialists. This study aimed to investigate the knowledge and attitude of emergency physicians working in Iran about the prescription of tissue Plasminogen Activator (tPA) in AIS. Methods: This was a cross-sectional questionnaire-based study including EM physicians working in different cities of Iran in 2020. A previously used English questionnaire was translated into Persian. After face validity and reliability assessment, the final questionnaire was designed as a Google form and sent to 400 EM professionals. Results: 128 physicians filled in the forms. 64.8% of participants had sufficient attitude and 68% had sufficient knowledge about tPA treatment in AIS. The knowledge regarding tPA treatment was higher in the age>40 years, male gender and physicians with up-to-date information (P<0.05), but no significant association was found f...
Acta neurologica Belgica, 2007
The short time window is frequently cited as the main reason for exclusion of intravenous tissue plasminogen activator (tPA) in acute stroke. Identifying and circumventing barriers to thrombolysis other than time could increase the frequency of treatment. The goal of this study was to identify whether the rate of treatment with tPA would increase if time window was not an obstacle to treatment. In four hospitals we prospectively recorded the rate of tPA use in consecutive patients admitted with acute ischemic stroke and in those admitted within 3 hours, the reasons why thrombolysis was not given, and the potential gain in the rate of tPA use if all patients had been admitted within 3 hours considering all exclusion criteria other than time. We recruited 486 patients (258 men; mean age, 70.4 +/- 13.5 years), of whom 154 (31.7%) were admitted within 3 hours. The time of stroke onset was unknown in 28 (5.8%). The rate of tPA use was 11.1% in the whole study population and 35.1% in thos...
Barriers to Receiving Tissue Plasminogen Activator in Patients with Ischemic Stroke
Background: Cerebrovascular diseases are the second common cause of mortality worldwide. The onset of reperfusion in the first 3-4.5 hours is a predictive factor of treatment. Objective: The present study investigated barriers to receiving tissue plasminogen activator in patients with ischemic stroke. Methods: This cross-sectional study examined 191 patients with first-ever stroke referring to the emergency department of the Persian Gulf Martyrs Hospital of Bushehr City, Iran, in 2016. One checklist was completed which included demographic data, history of diseases, knowledge of stroke symptoms, and intervals regarding the onset of symptoms to informing emergency, informing emergency on arrival at the emergency department of the hospital, and making the diagnosis for the patients. The obtained data were analyzed in SPSS v. 19. Results: Mean±SD age of the patients was 65.92±12.48 years. The majority of patients under investigation (55.5%) were female, 63.4% were married, 56% were illiterate and 72.3% resided in other districts of Bushehr province. Mean duration between onset of symptoms and arrival at emergency department, onset of symptoms and call the emergency service, time of arrival at emergency department to perform brain Computer Tomography (CT) scan and also to be counseled by a neurologist were 699.66, 195.51, 45.11 and 423.62 minutes, respectively. Finally 14.6 percent of patients were qualified to be treated with tPA. Conclusion: The main barrier to timely therapy is a delay in golden time. Therefore, public education to promote public awareness could be of great benefit in reducing the referral delay time.
PLoS ONE, 2014
Objective: To assess emergency physicians' perceptions of individual and system enablers to the use of tissue Plasminogen Activator in acute stroke. Method: Australian fellows and trainees of Australasian College for Emergency Medicine completed a 57-item online survey assessing enablers to implementation of evidence-based practice across six domains: knowledge, skills, modelling, monitoring, feedback, and maintenance. Demographic and workplace characteristics were obtained. Descriptive statistics were calculated to describe demographic and workplace characteristics of responders, and survey responses. Each domain received an overall score (%) based on the number of responders agreeing with all items within the domain. Results: A total of 429 (13%) Australasian College for Emergency Medicine members responded. 17.7% of respondents reported they and/or their workplace met all knowledge-related enablers, however only 2.3% had all skill-related enablers in place. Of respondents who decide which patients receive tissue Plasminogen Activator treatment, 18.1% agreed that all maintenance-related enablers are in place at their hospital, compared to 6.6% for those who do not decide which patients receive tissue Plasminogen Activator treatment. None of the respondents had all items in place cross all domains. Conclusions: Even when allowing for the low response rate, it seems likely there is a lack of individual and system enablers supporting the implementation of bestpractice stroke care in a number of Australian hospitals. Quality improvement programs could target all domains, particularly the skills-training and feedback emergency physicians receive, to aid implementation of tissue Plasminogen Activator treatment for acute stroke.
Background: In ischemic stroke, administration of tissue plasminogen activator (tPA) within 4.5 hours from the time last known well (LKW) improves outcomes, with better outcomes seen with earlier administration. However, for patients presenting early, a perception of significant remaining time within this window may lead to delayed tPA administration. We hypothesized that cases with a shorter LKW-to-stroke team activation (code) time will have a longer " code-to-tPA " administration time. Methods: In the Mount Sinai Hospital Stroke Registry (2009-2015), 122 patients received tPA. The patients were divided by " LKW-to-code " time into 3 groups: 0-59 minutes (n = 38), 60-119 minutes (n = 49), and 120 minutes or more (n = 35). The code-to-tPA time was compared among these groups, adjusting for age, sex, National Institutes of Health Stroke Scale (NIHSS) score, and race–ethnicity. Results: The average code-to-tPA time was 80 minutes in the 0-59 minutes group, 67 minutes in the 60-119 minutes group, and 52 minutes in the 120 minutes or more group (analysis of variance P < .0001). There was an average 28-minute difference (P = .021) between the 0-59 and 120 minutes or more groups. Conclusion: There was a significant negative correlation between the LKW-to-code time and the code-to-tPA time that was independent of age, sex, NIHSS score, and race–ethnicity. Key Words: Ischemic stroke—cerebrovascular disease—quality improvement— tPA—alteplase.
The Outcome of Treatment With Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke
Background: Thrombolytic therapy is the recommended treatment of acute ischemic stroke. It is crucial to evaluate the treatment results with recombinant Tissue Plasminogen Activator (r-TPA) in patients with acute stroke. Objectives: This study aimed to evaluate treatment outcomes with r-TPA in patients with acute stroke in a referral stroke center in Iran. Materials & Methods: In this retrospective study, 87 patients with symptoms of acute stroke were examined. They were referred to a stroke center in Gilan Province, Iran, from June 2016 to April 2020 and received r-TPA (0.9 mg/kg). Demographic information, the time interval between the onset of symptoms and r-TPA administration, complications, and National Institutes of Health Stroke Scale (NIHSS) upon arrival and discharge and death of patients were extracted from their hospital files. The paired t-test, independent t-test, and Pearson correlation test were used to compare variables using IBM SPSS for Windows version 20.0 (IBM Corp., Armonk, NY, USA). Results: The Mean±SD of NIHSS reduced from 14.7±6.4 to 8.9±7.6 (P<0.001). The most common complication was Intracerebral Hemorrhage (ICH) (12.6%). The hospital mortality rate was 23%. ICH occurred among 40% (n=8) of those who expired, and 4.47% (n=3) of them survived, and this difference was significant (P<0.001). Conclusion: The recovery with r-TPA administration in the stroke center was acceptable. Mortality and ICH occurrence rates were higher than other non-Iranian studies. It seems that we should change the case selection criteria and prescription dose to achieve better results of treatment with TPA.
Iranian Journal of Neurology, 2018
Background: Tissue plasminogen activator (tPA) has been long approved as an efficacious treatment in patients with acute ischemic stroke (AIS); however, due to some serious complications, particularly intracranial hemorrhage (ICH), many physicians are still reluctant to use it liberally. This study sought to find potential prognostic factors in patients with AIS treated with tPA. Methods: A retrospective, hospital-bases observational study was conducted. Consecutively, a total of 132 patients with AIS treated with intravenous tPA, form June 2011 to July 2015 were enrolled. Inclusion and exclusion criteria were based on updated guidelines. Probable prognostic variables were examined separately in three distinct groups; the occurrence of ICH within 24 hours after treatment, poor 3-month outcome on the basis of modified Rankin Scale (mRS) and 3-month mortality. Results: Patients were 83 men (62.9%) and 49 women (37.1%) with a median age of 66 years [interquartile range (IQR)of 55-72]. ...
2010
Background and Purpose-Some patients with mild or improving ischemic stroke symptoms do not receive intravenous tissue plasminogen activator (tPA) because they look "too good to treat" (TGT); however, some have poor outcomes. Methods-We retrospectively analyzed data from a prospective single-center study between 2002 and 2004. TGT patients were those arriving within 3 hours of symptom onset and not treated with intravenous tPA solely because of mild or improving symptoms. Results-Of 128 patients presenting within 3 hours, 41 (34%) were not given tPA because of mild or improving stroke.