Open AccessPatient refusal of thrombolytic therapy for suspected acute ischemic stroke
Author(s) -
Vahidy F. S.,
Rahbar M. H.,
Lal A. P.,
Grotta J. C.,
Savitz S. I.
Publication year - 2015
Publication title -
international journal of stroke
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.375
H-Index - 74
eISSN - 1747-4949
pISSN - 1747-4930
DOI - 10.1111/j.1747-4949.2012.00945.x
Subject(s) - medicine , stroke (engine) , demographics , incidence (geometry) , ischemic stroke , single center , pediatrics , surgery , ischemia , mechanical engineering , physics , demography , optics , sociology , engineering
Objective To determine factors associated with patients refusing IV t‐ PA for suspected acute ischemic stroke ( AIS ), and to compare the outcomes of patients who refused t‐ PA ( RT ) with those treated with t‐ PA . Methods Patients who were treated with and refused t‐ PA at our stroke center were identified retrospectively. Demographics, clinical presentation, and outcome measures were collected and compared. Clinical outcome was defined as excellent ( mRS : 0–1), good ( mRS : 0–2), and poor ( mRS : 3–6). Results Over 7·5 years, 30 (4·2%) patients refused t‐ PA . There were no demographic differences between the treated and RT groups. The rate of RT decreased over time ( OR 0·63, 95% CI 0·50–0·79). Factors associated with refusal included a later symptom onset to emergency department presentation time ( OR 1·02, 95% CI 1·01–1·03), lower NIHSS ( OR 1·11, 95% CI 1·03–1·18), a higher proportion of stroke mimics ( OR 17·61, 95% CI 6·20–50·02) and shorter hospital stay ( OR 1·32, 95% CI 1·09–1·61). Among patients who were subsequently diagnosed with ischemic stroke, only length of stay was significantly shorter for refusal patients ( OR 1·37, 95% CI 1·06–1·78). After controlling for mild strokes and stroke mimics, clinical outcome was not different between the groups ( OR 1·61, 95% CI 0·69–3·73). Conclusion The incidence of patients refusing t‐ PA has decreased over time, yet it may be a cause for t‐ PA under‐utilization. Patients with milder symptoms were more likely to refuse t‐ PA . Refusal patients presented later to the hospital and had shorter hospital stays. One out of six refusal patients (16·6%) had a stroke mimic.