Factors Associated With In-hospital Delayed Treatment With Intravenous Recombinant Tissue Plasminogen Activator In Patients With Acute Ischemic Stroke

Objectives To explore the factors associated with in-hospital delayed treatment with intravenous recombinant tissue plasminogen activator(rt-PA)in patients with acute ischemic stroke.Methods From January 2006 to May 2015,a total fo 220 consecutive patients with acute ischemic stroke with intravenous thrombolysis were admitted to the Department of Neurology,Tangshan Gongren Hospital.In this study,all patients were treated with intravenous recombinant tissue plasminogen within 4.5 hours of symptom onset.According to door-to-neddle time(DNT),they were divided into either a delay group(DNT>1h;n=151)or a non-delay group(DNT?1h;n=69).The baseline data,laboratory tests,onset-to-door(OTD)time,imaging,and etiology classification of trial org 10172 in acute stroke treatment(TOAST)of both groups were recorded.Univatiate analysis was performed on both groups,and further multivariate logistic was performed.Results Of 220 patients enrolled in this study,151(68.6%)patients experienced inhospital delayed thrombolytic treatment.The non in-hospital delay group in the rate of previous transient ischemic attacks,onset-to-door time(OTD),blood glucose level were higher than the in-hospital dealy.There were significant differences between the two groups[43.5%(30/69)vs.3.3%(5/151),(7.9 ± 3.0)mmol/L vs.(6.9 ± 2.1)mmol/L,(95±53)min vs.(80±34)min,all P<0.05].Trial of Org 10172 in acute stroke treatment(TOAST)of the 2 groups were statistically significant(P<0.05).There were no significantly difference in other baseline data between the 2 groups(all P>0.05).The result of logistic regression analysis showed that the patients with previous transient ischemic attack(OR=0.330,95% CI=0.109~0.998,P=0.046),blood glucose(increased by 1 mmol/L: OR=0.775,95%CI=0.657~0.914,P=0.005),onset-to-door time(increased by 30 min: OR=0.648,95%CI=0.504~0.831,P=0.013),internal carotid artery disease(OR=0.192,95%CI=0.038~0.960,P=0.044)have lower risk of thrombolysis for inhospital delay.systolic blood pressure(increased by 10 mm Hg: OR=1.275,95%CI=1.091~1.491,P=0.027),cardioembolism(OR=3.892,95%CI=1.661~9.112,P=0.006)and stroke of other determined or undetermined etiology(OR=3.114,95% CI=1.022~9.486,P=0.012).have higher risk of thrombolysis for patients with ischemic stroke in-hospital delay.Conclusions The patients with previous transient ischemic attack,higher blood glucose,prolonged onset-to-door time and having internal carotid artery disease may be cause the attention of family members and doctors,and were less prone to having thrombolytic inhospital delay,whereas those with higher systolic blood pressure,cardioembolism,other determined or undetermined etiology were more likely to have delayed use of rt-PA after admission.