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QJM Advance Access originally published online on February 5, 2008
QJM 2008 101(4):291-298; doi:10.1093/qjmed/hcn002
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© The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Implementation of a stroke thrombolysis service within a tertiary neurosciences centre in the United Kingdom

Michael T. McCormick1, Ian Reeves2, Tracey Baird3, Ian Bone3 and Keith W. Muir1

From the 1Division of Clinical Neurosciences, University of Glasgow, 2Department of Medicine for the Elderly and 3Department of Neurology and, Institute of Neurological Sciences, Southern General Hospital, Glasgow, G51 4TF, UK

Address correspondence to Dr Michael McCormick, Division of Clinical Neurosciences, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow, G51 4TF, UK. email: michael.mccormick{at}clinmed.gla.ac.uk

Received 16 August 2007 and in revised form 28 December 2007


  Abstract

Background: Intravenous alteplase is licensed for treatment of ischaemic stroke within 3 h of onset. Up to one-third of patients in the UK present to hospital within this time window but few are treated. Aims: To examine the effect of a stroke thrombolysis protocol on service provision for an acute stroke service in the UK, jointly run by Neurology and Medicine for the Elderly providing a comprehensive stroke service to a local population of 370 000.

Design: Prospective observational study.

Methods: Data collected prospectively for all thrombolysis referrals over a 12-month period beginning July 2004.

Results: One hundred and eighty-eight patients were referred for potential thrombolysis, 129 transferred, 102 had an ischaemic stroke and 49 received intravenous thrombolysis. Referral rates from primary care and accident and emergency increased after guideline dissemination. Forty-three percent of the 49 patients treated with intravenous rt-PA achieved independence (modified Rankin Scale score 0–2) at 3months.

Conclusions: A high proportion of ischaemic stroke patients can be treated with alteplase within 3 h of onset with organized hospital services and dissemination of a simple referral protocol to local primary and secondary care services.


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