Skip Navigation

This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (24)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Kwan, J.
Right arrow Articles by Sandercock, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kwan, J.
Right arrow Articles by Sandercock, P.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Q J Med 2004; 97: 273-279
QJM vol. 97 no. 5 (c) Association of Physicians 2004; all rights reserved.

Improving the efficiency of delivery of thrombolysis for acute stroke: a systematic review

J. Kwan1, P. Hand2 and P. Sandercock3

From the 1University Department of Geriatric Medicine, Southampton General Hospital, , Southampton, UK, 2Department of Neurology, Royal Melbourne Hospital, Parkville, Australia, and 3Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK

Received 20 November 2003 and in revised form 13 January 2004

Background: Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is licensed for use within 3 h of acute ischaemic stroke. The less the delay to treatment, the more likely it is to be effective.

Aims: To assess the effectiveness of interventions designed to overcome barriers to rapid administration of thrombolytic therapy.

Design: Systematic review of previous clinical studies.

Methods: We searched for studies that evaluated the effect of an intervention to reduce delays to administration of rt-PA. We searched MEDLINE, EMBASE, the trials register of the Cochrane Stroke Group, and the Cochrane Controlled Trials Register. We sought randomized and non-randomized controlled trials, before-and-after studies, interrupted time series, and observational studies.

Results: We identified 10 non-randomized studies that evaluated interventions that could speed up admission to hospital and administration of rt-PA. The types of interventions included: (a) education programmes for the public to improve their knowledge about symptoms of acute stroke; (b) training programmes for paramedical staff to improve their accuracy of stroke diagnosis and hasten transport of the patient to hospital; (c) helicopter transfer of patients to hospital; (d) training programmes in acute stroke therapy for emergency department staff; and (e) re-organization of in-hospital systems to streamline acute stroke care. Several programmes were multifaceted interventions.

Discussion: We identified important areas that could be targets for interventions to improve the efficiency of delivering thrombolysis for acute stroke. Multifaceted programmes might be more likely to be successful in reducing delays to therapy.

Address correspondence to Dr J. Kwan, University Department of Geriatric Medicine, Level E Mailpoint 807, Southampton General Hospital, Tremona Road, Southampton SO16 6YD. e-mail: jk{at}1to1.org


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 StrokeHome page
J. D.H. van Wijngaarden, M. Dirks, R. Huijsman, L. W. Niessen, I. N. Fabbricotti, D. W.J. Dippel, and the Promoting Acute Thrombolysis for Ischaemic Str
Hospital Rates of Thrombolysis for Acute Ischemic Stroke: The Influence of Organizational Culture
Stroke, October 1, 2009; 40(10): 3390 - 3392.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
J. Muller-Nordhorn, K. Wegscheider, C. H. Nolte, G. J. Jungehulsing, K. Rossnagel, A. Reich, S. Roll, A. Villringer, and S. N. Willich
Population-Based Intervention to Reduce Prehospital Delays in Patients With Cerebrovascular Events
Arch Intern Med, September 14, 2009; 169(16): 1484 - 1490.
[Abstract] [Full Text] [PDF]

Home page
 Arch NeurolHome page
S. R. White-Bateman, H. C. Schumacher, R. L. Sacco, and P. S. Appelbaum
Consent for Intravenous Thrombolysis in Acute Stroke: Review and Future Directions
Arch Neurol, June 1, 2007; 64(6): 785 - 792.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
T. R. Yip and B. M. Demaerschalk
Estimated Cost Savings of Increased Use of Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in Canada
Stroke, June 1, 2007; 38(6): 1952 - 1955.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
L. Ehlers, G. Andersen, L. B. Clausen, M. Bech, and M. Kjolby
Cost-Effectiveness of Intravenous Thrombolysis With Alteplase Within a 3-Hour Window After Acute Ischemic Stroke
Stroke, January 1, 2007; 38(1): 85 - 89.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
O. Agyeman, K. Nedeltchev, M. Arnold, U. Fischer, L. Remonda, J. Isenegger, G. Schroth, and H. P. Mattle
Time to Admission in Acute Ischemic Stroke and Transient Ischemic Attack
Stroke, April 1, 2006; 37(4): 963 - 966.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
D. Hanley and W. Hacke
Critical Care and Emergency Medicine Neurology in Stroke
Stroke, February 1, 2005; 36(2): 205 - 207.
[Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.