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P183 Background T-PA is an effective treatment of acute  ischemic stroke within 3 hours. However, the success of t-PA on  reducing disability is dependent on it being accessible to more  patients. We identified the reasons why patients with ischemic stroke  did not receive intravenous t-PA and assessed the community impact of  the therapy in a large North American city.Methods Consecutive patients with acute ischemic stroke were identified in a  prospective stroke registry at a teaching hospital between October 1996  and December 1999. Additional patients with ischemic stroke admitted to  one of three other hospitals during the study period were identified.  The Oxford Community Stroke Program Classification was used to record  stroke type.Results Of 2165 stroke patients presenting to  the emergency department 1179 (54.5%) were diagnosed with ischemic  stroke, 31.7% with intracranial hemorrhage, and 13.8 % with transient  ischemic attack. 84/339 (29%) patients were admitted within 3 hours of  stroke received intravenous t-PA. The major reasons for exclusion for  stroke patients presenting within 3 hours were mild stroke (20%),  clinical improvement (18.6%), and specific protocol exclusions  (11.5%). Delay in presentation to emergency department excluded  840/1179 (71%). 1817 ischemic stroke patients were admitted to Calgary  hospitals during the study period of which 4.6% received intravenous  t-PA. Generalization of the Calgary experience to other Canadian  communities suggests the benefit from t-PA for ischemic stroke may be  substantial with an additional 460 independent survivors per annum.Conclusion The effectiveness of t-PA can be improved by  understanding why patients are excluded from its use. The eligibility  of patients for t-PA must increase by promoting health education  programs and by developing organized acute stroke care infrastructure  within the community.

stroke

Why Stroke Patients Don’t Receive T-PA? An Analysis of Patient Eligibility: Implications for Improving Clinical Impact by Increasing Future Treatment Numbers