Australian guidelines back tPA in acute stroke

A position statement from the National Stroke Foundation and Stroke Society of Australia has supported the use of intravenous tPA in carefully selected patients within three hours of stroke onset, but only in specialised units which have appropriate skills and infrastructure. A registry maintained by 14 hospitals identified 518 patients treated with tPA to October 2008, and the efficacy and safety outcomes were equivalent to international benchmarks. Although the rate of use remained low, it was increasing. “Implementing tPA therapy in clinical practice is, however, challenging and requires a coordinated multidisciplinary approach...across prehospital, emergency department and inpatient care sectors,” the statement noted. “Stroke care units are an essential ingredient underpinning safe implementation of stroke thrombolysis.” In Australia it was estimated that 45% of patients arrived at hospital within three hours of stroke onset. Although there was evidence that thrombolysis could be helpful if given up to 4.5 hours after an ischaemic stroke, the risk-benefit margin was narrower. An editorial noted that tPA was now a proven acute treatment, and it was time that emergency departments treated patients with a possible stroke similarly to those with acute chest pain. Internal Medicine Journal 2009; 39: 317-324.  ...