Analysis of the reasons for exclusion from tPA therapy after early arrival in acute stroke patients

Clin Neurol Neurosurg. 2007 Jan;109(1):50-3. doi: 10.1016/j.clineuro.2006.06.006. Epub 2006 Aug 2.


Objective: Only a small percentage of patients with acute stroke receive thrombolytic therapy, mainly due to late hospital arrival. Factors excluding those who arrive within 3h after stroke onset are less well known.

Patients and methods: During the first year after implementing a protocol for stroke thrombolysis, we prospectively evaluated all patients with stroke admitted to our center within 3h from onset. Within-hospital time intervals were calculated and the reasons for exclusion from thrombolysis were analyzed.

Results: Ninety-six patients (representing 16% of all stroke patients admitted) arrived in less than 3h, and 25 of them (representing 7.5% of all patients with ischemic stroke) received thrombolytic therapy, with a door-to-needle interval of 51 min (range, 33-121). The reasons that accounted for 75% of therapy exclusions were non-modifiable (a too mild or improving deficit, and intracranial hemorrhage), except for a time window exceeded, which would probably require increasing public awareness about stroke.

Conclusions: Most reasons for not applying thrombolysis to patients who arrive early enough are non-modifiable. Minimizing the door-to-needle time could compensate for late hospital arrival, which continues to be the main reason for not applying this therapy to stroke patients throughout the world.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Early Diagnosis
  • Emergency Service, Hospital*
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Prospective Studies
  • Stroke / diagnosis
  • Stroke / drug therapy*
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage*
  • Trauma Severity Indices


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator