Factors Associated with Poor Clinical Outcome after Intravenous Recombinant Tissue Plasminogen Activator (rt-PA) for Acute Ischemic Stroke in Northeastern Thailand
Vorasoot N, MD1,2, Sothornwit J, MD1,2, Chomjit A, MD3, Kasemsap N, MD1,2, Tiamkao S, MD1, Sawanyawisuth K, MD, PhD1,4, Kongbunkiat K, MD1,2
Affiliation : 1 Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 2 North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand 3 Department of Neurology and Neurosurgery, Royal Phnom Penh Hospital, Phnom Penh, Cambodia 4 Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Research and Training Center for Enhancing Quality of Life of Working Age People, Khon Kaen University, Khon Kaen, Thailand
Objective : To evaluate the factors associated with poor treatment outcomes of acute ischemic stroke after intravenous recombinant
tissue plasminogen activator (rt-PA) therapy from 7 hospitals in Northeastern Thailand.
Materials and Methods : The present study was a retrospective analytical study. Data were obtained from medical records of acute
ischemic stroke patients who reached hospital within 4.5 hours after onset and received rt-PA during 2008 May to 2012 April. The
authors evaluated time and process to access hospital, duration of treatment process, and factor associated with good and poor
clinical outcomes.
Results : During the study period, 778 patients met the study criteria. Mean onset-to-door time was 1.85+1.05 hours. Previous
visiting medical center unavailable for rt-PA made patients delay reaching hospitals (OR 1.62 (95% CI 1.28 to 2.04), p-value <0.001).
Mean onset-to-needle time was 3.08+1.11 hours. Factors leading to poor outcome were atrial fibrillation (AF) (OR 2.38 (95% CI
1.33 to 4.23), p-value = 0.003) and onset-to-needle time more than 180 minutes (OR 14.78 (95% CI 7.91 to 27.62), p-value <0.001).
Conclusion : Patients came to hospital late because of previously visiting medical centers where rt-PA-was unavailable. Atrial
fibrillation and onset-to-needle time more than 180 minutes associated to poor outcome.
Keywords : Poor outcomes, rt-PA, Ischemic stroke
