IV tPA for acute ischemic stroke - Results of the first 101 patients in a community practice

Background: Reviews of the use of intravenous tissue type plasminogen activator (IV tPA) for acute stroke in community hospitals have raised questions regarding its safe use in community practice settings outside major academic stroke centers. Many neurologists have been reluctant to use TV tPA in their practices. We therefore analyzed the experience of this community neurology practice in treating acute strokes with IV tPA. Review Summary: We retrospectively reviewed our treatment experience for 101 patients given IV tPA in one community neurology practice in 3 Cleveland-area hospitals between 1997 and 2003. Symptomatic hemorrhage occurred in 2 of 101 patients who received IV tPA. Median National Institutes of Health Stroke Scale (NIHSS) was 10.8 pretreatment, 3 at 24 hours, and 2.1 on hospital discharge. IV tPA treatment rate increased from 4.7% to 10.3% between 1999 and 2003. Conclusion: IV tPA for acute ischemic stroke can be given safely and effectively by physicians in an independent neurology practice in the community hospital setting.