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Toronto Acute Stroke Protocol Increases Timely Thrombolysis

Treatment protocol leads to six-fold increase in number of patients receiving tPA within 2.5 hours

FRIDAY, Oct. 30 (HealthDay News) -- An acute stroke treatment protocol in which patients were taken directly to a regional stroke center instead of the closest local hospital resulted in a six-fold increase in the number of patients receiving tissue plasminogen activator (tPA) within 2.5 hours of symptom onset over a four-month study period, according to a report published online Oct. 29 in Stroke.

David J. Gladstone, M.D., of the Sunnybrook Health Sciences Centre in Toronto, and colleagues compared the outcomes for stroke patients during the first four months under the new city-wide stroke protocol implemented in 2005 with outcomes during the same period in 2004.

Under the new protocol, the researchers found that the number of suspected stroke patients arriving at a regional stroke center within 2.5 hours of onset of symptoms increased from 66 to 141, while the number of ischemic stroke patients eligible for and treated with tPA within 2.5 hours increased from five to 30. The median symptom onset-to-needle time for treated patients decreased from 195 to 141 minutes.

"This prehospital triage was immediately successful in improving tissue plasminogen activator access for patients with ischemic stroke, enabling our center to deliver one of the highest tissue plasminogen activator treatment rates in North America and underscoring the need for coordinated systems of acute stroke care. Sustainability of such an initiative is dependent on interdisciplinary teamwork, ongoing paramedic training, adequate hospital staffing, bed availability, and repatriation agreements with community hospitals," the authors write.

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