INTRODUCTION: Intravenous administration of Recombinant Tissue Plasminogen Activator (IV-rTPA) has been an essential component of reperfusion treatment strategies in the aftermath of the 1995 National Institute of Neurological Disorders and Stroke (NINDS) TPA Stroke Study. However, it remains to be under-utilized both nationally and worldwide. Local data on thrombolytic use are very limited.

OBJECTIVES: This study aims to document our institution's experience with the use of intravenous thrombolysis in acute ischemic stroke cases by describing the demographic, clinical, radiographic, and management profiles of all our patients who were given IV - rTPA and their functional outcomes upon discharge and after three months.

METHOD: This is a descriptive study utilizing a clinical series design. Chart review of eighteen (18) patients who were admitted in our institution--a tertiary private hospital--due to acute ischemic stroke from January 2007 to August 2009 and who has given IV- rTPA was done. The patients' functional outcomes measured by the Modified Rankin Scale (MRS) upon discharge and at three months after stroke onset were documented by reviewing the patients' inpatient and outpatient records and by telephone interview conducted with the patients and/or their relatives.

RESULTS: The mean age of patients thrombolysed in our institution was 57.11 + 13.5 years (range: 31 to 80 years). All cases, except for one vertebrobasilar stroke, were anterior circulation strokes. Mean ictus-to-needle time frame for all thrombolysed patients was 174.3 + 56.6 minutes. The mean rTPA dose given to our patients was 0.87 + 0.08 mg/kg. A total 77.8% patients (14 of 18) received the standard rTPA dose of 0/9 mg/kg. Fourteen patients had follow-up imaging post-rTPA. Among these, 21.4% (3 of 14) developed non-symptomatic intracerebral hemorrhage (NSICH); 7.1% (1 of 14) developed a fatal symptomatic intracerebral hemorrhage (SICH). The mean baseline National Institutes of Health Stroke Scale (NIHSS) score of all patients was 14.9 + 5.9 (range: 4 to 24). Mean NIHSS score within the first 24 hours post-rTPA was 8.8 ± 6.1 (range: 0 to 19)--a 41% improvement from baseline. Eleven patients (11 of 18) or 61.1% were noted to have early improvement or an improvement of NIHSS score within the first 24 hours by ≥ 4. The mean follow-up NIHSS score beyond the first 24 hours post-rTPA was 5.5 ± 5.3 (range: 0 to 18), obtained at an average of 4.8 ± 2.4 days post-thrombolysis--a 63% improvement from the baseline mean NIHSS score. The mean MRS score of all patients upon hospital discharge was 3.17 ± 1.69. Two patients (2 of 18) or 11.1% expired 4 and 5 days post-thrombolysis; two (2 of 18) were lost to follow-up. For those who survived to discharge and not lost to follow-up (n=14), the mean MRS score at three months was noted to be 1.50 ± 1.09--a 53% improvement from mean MRS upon discharge. Seven of 18 patients (39%) had a favorable outcome defined as MRS ≤ 1 at three months post thrombolysis. Protocol deviations in our hospital were reported in 16.7% (3 of 18).

CONCLUSION: Our study showed trends to early improvement and favorable outcomes among stroke patients given IV-rTPA within 3 to 4.5 hours from ictus in our institution--with NIHSS scores improving by 40 to 60% during the course of their hospital stay, and 39% of patients having minimal or no disability at 3 months using the MRS. Our institution has more experience the standard rTPA dose of 0.9 mg/kg. A hospital brain rack team (BAT) that is on-call 24 hours' aids in the facilitation of thrombolytic treatment in acute ischemic strokes.