Better Assessment Of Stroke Improves Use Of Thrombolytic Therapy

by VR Sreeraman on Nov 18 2007 1:28 PM

Comprehensive protocols in emergency departments (EDs) can allow rapid assessment of stroke patients eligible for early-stage treatment, according to a study published in the latest Medical Journal of Australia.

Stroke is the third most common cause of death and a major cause of disability in Australia.

Dr Romesh Markus and his co-authors from St Vincent’s Hospital in Sydney and The University of New South Wales conducted a study into whether or not the introduction of a protocol-driven assessment of stroke patients in the ED could safely and effectively identify patients eligible for thrombolysis.

Thrombolysis is currently the only approved medical therapy for patients with acute ischaemic stroke.

Patients who receive thrombolysis within three hours of ischaemic stroke onset are at least 30 per cent more likely to have little or no disability compared with those who don’t receive the treatment.

Despite this, only about one per cent of ischaemic stroke patients in Australia receive thrombolytic therapy, mostly because many patients present to the ED too late to receive treatment.

Dr Markus and his co-authors found that protocols for the assessment of acute stroke in the ED helped identify those patients eligible for thrombolytic therapy.

“Rapid triage, assessment and investigation in the ED of stroke patients presenting within three hours of symptom onset enabled thrombolytic therapy in 95 per cent of eligible patients,” Dr Markus says.

“Two thirds of ischaemic stroke patients receiving thrombolysis following this protocol were functionally independent at three months.”

Dr Markus suggests stroke centres with no previous experience of acute stroke thrombolysis could routinely use this therapy with safety and efficacy provided there is strict adherence to and monitoring of protocols.

In a related editorial in the Journal, Professor Stephen Davis, Director of Neurology at the Melbourne Neuroscience Centre, and his co-authors, say public education about stroke symptoms can help increase the use of thrombolytic therapy.

“A key barrier to the use of thrombolytic therapy is delayed arrival to hospital after stroke onset,” Prof Davis says.

“The public must be educated to call an ambulance, not a general practitioner, when stroke symptoms occur.”

Prof Davis says that rapid ambulance transport to a hospital with an organised acute stroke team is also essential to improving access to thrombolysis.

The Medical Journal of Australia is a publication of the Australian Medical Association.