The most common reasons for acute ischemic stroke patients not receiving IV tPA in China
ZhipingHu, Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha 410011, Cliyatou.hi@163.com
Chunli Chen; Liuwang Zeng, Changsha, China
Submitted October 20, 2016
We read with interest the article by Messe et al. [1] In the study, 15,282 patients in the United States with acute ischemic stroke (AIS) did not receive IV tPA treatment within 3 hours; the most common reasons were mild or rapidly improving symptoms (51%) and advanced age (7%). [1]
Over 4 million people suffer from AIS each year in China, [2] but the proportion receiving tPA is extremely low. Data from the Chinese National Stroke Registry showed that only 181 (12.3%) of 1469 eligible patients with AIS received tPA treatment. [3]
Last year, our institution reviewed 124 eligible patients with AIS who arrived at the hospital within 2 hours of AIS onset, only 28 (22.6%) received IV tPA. Patients failed to receive tPA treatment due to patient or family refusal (74%), physicians' conservative attitude (10%), mild or rapidly improving symptoms (9%), etc. (these reasons may be more common in China). Lack of tPA treatment may also be attributed to overemphasis on the complications of tPA, tense doctor-patient relationships, and expensive tPA fees. It is time that this issue arise mass concern. Rapid improvements in health-care systems and public awareness are expected to increase the rate of thrombolysis in China.
1. Messe SR, Khatri P, Reeves MJ, et al. Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry. Neurology Epub 2016 Sep 14.
2. Liu M, Wu B, Wang WZ, et al. Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol 2007;6:456-464.
3. Wang Y, Liao X, Zhao X, et al. Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China: analysis of the results from the Chinese National Stroke Registry (CNSR). Stroke 2011;42:1658-1664.
For disclosures, please contact the editorial office at journal@neurology.org.
We read with interest the article by Messe et al. [1] In the study, 15,282 patients in the United States with acute ischemic stroke (AIS) did not receive IV tPA treatment within 3 hours; the most common reasons were mild or rapidly improving symptoms (51%) and advanced age (7%). [1]
Over 4 million people suffer from AIS each year in China, [2] but the proportion receiving tPA is extremely low. Data from the Chinese National Stroke Registry showed that only 181 (12.3%) of 1469 eligible patients with AIS received tPA treatment. [3]
Last year, our institution reviewed 124 eligible patients with AIS who arrived at the hospital within 2 hours of AIS onset, only 28 (22.6%) received IV tPA. Patients failed to receive tPA treatment due to patient or family refusal (74%), physicians' conservative attitude (10%), mild or rapidly improving symptoms (9%), etc. (these reasons may be more common in China). Lack of tPA treatment may also be attributed to overemphasis on the complications of tPA, tense doctor-patient relationships, and expensive tPA fees. It is time that this issue arise mass concern. Rapid improvements in health-care systems and public awareness are expected to increase the rate of thrombolysis in China.
1. Messe SR, Khatri P, Reeves MJ, et al. Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry. Neurology Epub 2016 Sep 14.
2. Liu M, Wu B, Wang WZ, et al. Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol 2007;6:456-464.
3. Wang Y, Liao X, Zhao X, et al. Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China: analysis of the results from the Chinese National Stroke Registry (CNSR). Stroke 2011;42:1658-1664.
For disclosures, please contact the editorial office at journal@neurology.org.