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Intravenous thrombolysis for ischemic stroke in the Veneto region: the gap between eligibility and reality

  • Stefano Forlivesi
  • Manuel Cappellari
  • Claudio Baracchini
  • Federica Viaro
  • Adriana Critelli
  • Carmine Tamborino
  • Simone Tonello
  • Silvia Vittoria Guidoni
  • Martina Bruno
  • Silvia Favaretto
  • Alessandro Burlina
  • Emanuele Turinese
  • Franco Ferracci
  • Sandro Zambito Marsala
  • Salvatrice Bazzano
  • Federica Orlando
  • Michelangelo Turazzini
  • Silvia Ricci
  • Morena Cadaldini
  • Floriana De Biasia
  • Sandro Bruno
  • Anna Gaudenzi
  • Michele Morra
  • Alessandra Danese
  • Roberto L’Erario
  • Monia Russo
  • Giampietro Zanette
  • Domenico Idone
  • Anna Maria Basile
  • Matteo Atzori
  • Maela Masato
  • Elisabetta Menegazzo
  • Francesco Paladin
  • Agnese Tonon
  • Giorgio Caneve
  • Giulio Bozzato
  • Alessandro Campagnaro
  • Simona Carella
  • Piero Nicolao
  • Roberta Padoan
  • Francesco Perini
  • Antonella De Boni
  • Alessandro Adami
  • Bruno Bonetti
  • Paolo Bovi
Article

Abstract

Intravenous thrombolysis (IVT) is the treatment of choice for most patients with acute ischemic stroke. According to the recently updated guidelines, IVT should be administered in absence of absolute exclusion criteria. We aimed to assess the proportion of ischemic strokes potentially eligible and actually treated with IVT, and to explore the reasons for not administering IVT. We prospectively collected and analyzed data from 1184 consecutive ischemic stroke patients admitted to the 22 Stroke Units (SUs) of the Veneto region from September 18th to December 10th 2017. Patients were treated with IVT according to the current Italian guidelines. For untreated patients, the reasons for not administering IVT were reported by each center in a predefined model including absolute and/or relative exclusion criteria and other possible reasons. Out of 841 (71%) patients who presented within 4.5 h of stroke onset, 704 (59%) had no other absolute exclusion criteria and were therefore potentially eligible for IVT according to the current guidelines. However, only 323 (27%) patients were eventually treated with IVT. Among 861 (73%) untreated patients, 480 had at least one absolute exclusion criterion, 283 only relative exclusion criteria, 56 only other reasons, and 42 a combination of relative exclusion criteria and other reasons. Our study showed that only 46% (323/704) of the potentially eligible patients were actually treated with IVT in the SUs of the Veneto region. All healthcare professionals involved in the acute stroke pathway should make an effort to bridge this gap between eligibility and reality.

Keywords

Ischemic stroke Thrombolysis Guidelines Eligibility Exclusion criteria 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Stefano Forlivesi
    • 1
  • Manuel Cappellari
    • 1
  • Claudio Baracchini
    • 2
  • Federica Viaro
    • 2
  • Adriana Critelli
    • 3
  • Carmine Tamborino
    • 3
  • Simone Tonello
    • 4
  • Silvia Vittoria Guidoni
    • 4
  • Martina Bruno
    • 5
  • Silvia Favaretto
    • 5
  • Alessandro Burlina
    • 6
  • Emanuele Turinese
    • 6
  • Franco Ferracci
    • 7
  • Sandro Zambito Marsala
    • 7
  • Salvatrice Bazzano
    • 8
  • Federica Orlando
    • 8
  • Michelangelo Turazzini
    • 9
  • Silvia Ricci
    • 9
  • Morena Cadaldini
    • 10
  • Floriana De Biasia
    • 10
  • Sandro Bruno
    • 11
  • Anna Gaudenzi
    • 11
  • Michele Morra
    • 12
  • Alessandra Danese
    • 12
  • Roberto L’Erario
    • 13
  • Monia Russo
    • 13
  • Giampietro Zanette
    • 14
  • Domenico Idone
    • 14
  • Anna Maria Basile
    • 15
  • Matteo Atzori
    • 15
  • Maela Masato
    • 16
  • Elisabetta Menegazzo
    • 16
  • Francesco Paladin
    • 17
  • Agnese Tonon
    • 17
  • Giorgio Caneve
    • 18
  • Giulio Bozzato
    • 18
  • Alessandro Campagnaro
    • 19
  • Simona Carella
    • 19
  • Piero Nicolao
    • 20
  • Roberta Padoan
    • 20
  • Francesco Perini
    • 21
  • Antonella De Boni
    • 21
  • Alessandro Adami
    • 22
  • Bruno Bonetti
    • 1
  • Paolo Bovi
    • 1
  1. 1.Stroke UnitAzienda Ospedaliera Universitaria Integrata VeronaVeronaItaly
  2. 2.Stroke UnitAzienda Ospedaliera Università di PadovaPaduaItaly
  3. 3.Stroke UnitOspedale dell’AngeloMestreItaly
  4. 4.Stroke UnitOspedale Ca’ FoncelloTrevisoItaly
  5. 5.Stroke UnitOspedale San Giacomo ApostoloCastelfranco VenetoItaly
  6. 6.Stroke UnitOspedale San BassianoBassano del GrappaItaly
  7. 7.Stroke UnitOspedale San MartinoBellunoItaly
  8. 8.Stroke UnitOspedale di PortogruaroPortogruaroItaly
  9. 9.Stroke UnitOspedale Mater SalutisLegnagoItaly
  10. 10.Stroke UnitOspedali Riuniti Padova Sud Madre Teresa di CalcuttaMonseliceItaly
  11. 11.Stroke UnitOspedale Santa Maria dei BattutiConeglianoItaly
  12. 12.Stroke UnitOspedale CazzavillanArzignanoItaly
  13. 13.Stroke UnitOspedale Santa Maria della MisericordiaRovigoItaly
  14. 14.Stroke UnitOspedale PederzoliPeschiera del GardaItaly
  15. 15.Stroke UnitOspedale Sant’AntonioPaduaItaly
  16. 16.Stroke UnitOspedale di MiranoMiranoItaly
  17. 17.Stroke UnitOspedale Santi Giovanni e PaoloVeniceItaly
  18. 18.Stroke UnitOspedale di CittadellaCittadellaItaly
  19. 19.Stroke UnitOspedale Alto VicentinoSantorsoItaly
  20. 20.Stroke UnitOspedale Santa Maria del PratoFeltreItaly
  21. 21.Stroke UnitOspedale San BortoloVicenzaItaly
  22. 22.Stroke UnitOspedale Sacro Cuore Don CalabriaNegrarItaly

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