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Quantitative and qualitative evaluation tool in planning stroke treatment strategies: the “Safe implementation of treatments in stroke Monitoring Study (SITS MOST)” registry


A decade ago, stroke was the first leading cause of morbidity and mortality in Croatia. Nowadays, we record reduction in stroke incidence, as well as stroke consequences—invalidity and mortality. These are due to long-term planned actions in the field of public health as well as actions performed by professional organizations. Today, we can be satisfied with improvement in that field, but there are still things we can improve, at the first place improvement of the emergency medicine network due to Croatian-specific topographical characteristics to reduce onset-to-door time. In this paper, we evaluated results from 11 Croatian hospitals in the period 11/2005–11/2012. To find out about the past and present state in applying thrombolytic therapy in Croatia and to plan further actions in light of new studies and efforts in Europe and in the world, all with the aim of improvement in stroke prevention and acute treatment resulting in reduction of stroke morbidity, mortality and symptomatic intracerebral hemorrhage as well as better functional outcome. Our results have shown that we improved stroke treatment in the last decade, but further actions should be performed to raise public stroke awareness and to improve emergency medicine network as well as in hospital protocols.

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  1. Hrabak-Žerjavić V, Kralj V, Dika Ž, Jelaković B (2010) Epidemiologija hipertenzije, moždanog udara i infarkta miokarda u Hrvatskoj. Medix 16:102–107

    Google Scholar 

  2. Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W, Hennerici MG, Kaste M, Kuelkens S, Larrue V, Lees KR, Roine RO, Soinne L, Toni D, Vanhooren G, SITS-MOST investigators (2007) Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 27(369):275–282

    Article  Google Scholar 


  4. Hacke W, Davalos A, von Kummer R, Kaste M, Larrue V (1999) ECASS-II: intravenous alteplase in acute ischaemic stroke. Lancet 353(9146):67–68

    Article  Google Scholar 

  5. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, ECASS Investigators (2008) Thrombolysis with Alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329

    CAS  PubMed  Article  Google Scholar 

  6. European Stroke Organisation (ESO) Executive Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 25:457–507

    Article  Google Scholar 

  7. Demarin V, Lovrenčić-Huzjan A, Trkanjec Z, Vuković V, Vargek-Solter V, Šerić V et al (2006) Recommendations for stroke management 2006 update. Acta Clin Croat 45:219–285

    Google Scholar 

  8. Adams HP Jr, Bendixen BH, Kappelle V, Biller J, Love BB, Gordon DL, Marsh EE 3rd (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24(1):35–41

    PubMed  Article  Google Scholar 

  9. Bamford J, Sandercock P, Dennis M et al (1988) A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project 1981-86 (methodology, demography and incident cases of first-ever stroke). J Neurol Neurosurg Psychiatry 51:1373–1380

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  10. Kaste Markku (2013) Stroke: advances in thrombolysis. Lancet Neurol 12(1):2–4

    PubMed  Article  Google Scholar 

  11. Smith EE, von Kummer R (2012) Door-to-needle times in acute ischemic stroke: How low can we go? Neurology 79:296–297

    PubMed  Article  Google Scholar 

  12. Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M (2012) Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology 79(4):306–313

    PubMed  Article  Google Scholar 

  13. Toni D, Ahmed N, Anzini A, Lorenzano S, Brozman M, Kaste M, Mikulik R, Putaala J, Wahlgren N, SITS investigators (2012) Intravenous thrombolysis in young stroke patients: results from the SITS-ISTR. Neurology 20(78):880–887

    Article  Google Scholar 

  14. Mikulík R, Kadlecová P, Czlonkowska A, Kobayashi A, Brozman M, Svigelj V, Csiba L, Fekete K, Kõrv J, Demarin V, Vilionskis A, Jatuzis D, Krespi Y, Ahmed N, Safe Implementation of Treatments in Stroke-East Registry (SITS-EAST) Investigators (2012) Factors influencing in-hospital delay in treatment with intravenous thrombolysis. Stroke 43(6):1578–1583

    PubMed  Article  Google Scholar 

  15. Mishra NK, Ahmed N, Davalos A, Iversen HK, Melo T, Soinne L, Wahlgren N, Lees KR, SITS and VISTA collaborators (2011) Thrombolysis outcomes in acute ischemic stroke patients with prior stroke and diabetes mellitus. Neurology 22(21):1866–1872

    Article  Google Scholar 

  16. The IST-3 collaborative group (2012) The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled tril. Lancet 379(9834):2352–2363

    PubMed Central  Article  Google Scholar 

  17. Supanc V, Vargek-Solter V, Bašić-Kes V, Breitenfeld T, Ramić S, Zavoreo I, Jergović K, Setić M, Biloglav Z, Demarin V (2009) The evaluation of the stroke unit in Croatia at the University Hospital Sestre milosrdnice, Zagreb: 1995-2006 experience. Coll Antropol 33(4):1233–1238

    PubMed  Google Scholar 

  18. Breitenfeld T, Vargek-Solter V, Supanc V, Roje-Bedeković M, Demarin V (2009) Stroke unit–where all stroke patients should be treated. Acta Clin Croat 48(3):341–344

    PubMed  Google Scholar 

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Correspondence to I. Zavoreo.

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Bašić Kes, V., Zavoreo, I., Vargek-Solter, V. et al. Quantitative and qualitative evaluation tool in planning stroke treatment strategies: the “Safe implementation of treatments in stroke Monitoring Study (SITS MOST)” registry. Acta Neurol Belg 114, 95–106 (2014).

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  • Thrombolytic therapy
  • Croatia
  • Onset-to-door time
  • Door-to-needle time