Hong Kong Med J 2012;18:92–8 | Number 2, April 2012
Is stroke thrombolysis safe and efficacious in Hong Kong?
Edward HC Wong, Alexander YL Lau, Yannie OY Soo, Deyond YW Siu, Venus SW Hui, Colin A Graham, Thomas WH Leung, Lawrence KS Wong
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
OBJECTIVE. To investigate the safety and efficacy of stroke thrombolysis in a local hospital.
DESIGN. Historical cohort study.
SETTING. A tertiary hospital in Hong Kong.
PATIENTS. The outcome of acute ischaemic stroke patients treated with intravenous tissue plasminogen activator between October 2008 and May 2011 was compared to those admitted during the same period who were thrombolysis-eligible, but treated conservatively due to unavailability of the thrombolysis service after-hours.
INTERVENTIONS. Intravenous tissue plasminogen activator.
MAIN OUTCOME MEASURES. Primary outcome was functional independence (modified Rankin Scale score of 2 or below) at 3 months. Safety outcomes were symptomatic intracranial haemorrhage and 3-month mortality. Secondary outcomes were hospital length of stay, direct home discharge, and nursing home discharge.
RESULTS. A total of 48 thrombolysis and 63 non-thrombolysis patients were identified. Fifty-two percent of the thrombolysis group achieved functional independence compared to 24% of nonthrombolysis group (P=0.003), without significant increase in mortality (15% vs 13%, P=0.51) or symptomatic intracranial haemorrhage (4% vs 2%, P=0.58). Twenty-nine percent of the thrombolysis group patients were discharged home directly, versus 6% of non-thrombolysis group (P<0.001). Mean length of stay was shorter for the thrombolysis group (25 vs 35 days; P=0.034). A similar percentage from each group was discharged to nursing homes.
CONCLUSION. Implementation of the stroke thrombolysis service in Hong Kong appeared safe and efficacious. Patients who received thrombolysis had better outcomes compared to non-thrombolysis cohort. Further studies are needed to investigate the economics of stroke thrombolysis in Hong Kong, which may help to improve funding for provision of this service.
Key words: Brain ischemia; Hong Kong; Stroke; Tissue plasminogen activator; Thrombolytic therapy
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