In-hospital stroke treated with intravenous tissue plasminogen activator.

BACKGROUND AND PURPOSE

In-hospital strokes (IHSs) are potential candidates for thrombolysis. We analyzed the treatment procedures, safety, and efficacy of intravenous tissue plasminogen activator (IV-tPA) in IHSs compared with out-of-hospital strokes (OHSs).

METHODS

This study was based on a multicenter prospective registry of patients treated with IV-tPA divided into IHSs and OHSs. We recorded intrahospital delays and stroke outcomes.

RESULTS

Among 367 patients treated with IV-tPA, 30 were IHSs. Baseline characteristics were similar except for a greater proportion of diabetes (36.7% vs 17.5%, P=0.01), cardiac failure (16.7% vs 5.3%, P=0.014), and atrial fibrillation (33.3% vs 17.5%, P=0.034) in IHSs than OHSs. In-hospital delays were significantly longer in IHSs for door-to-computed tomography time (39.5+/-18.7 vs 22.6+/-19.7 minutes, P<0.0001) and computed tomography-to-treatment time (92.0+/-26.1 vs 65.4+/-25.8 minutes, P<0.0001). No differences were observed in safety or efficacy.

CONCLUSIONS

In-hospital procedures for thrombolysis proceed more slowly in IHSs than in OHSs. Thrombolysis is safe and efficient in IHS.