Does the addition of non-approved inclusion and exclusion criteria for rtPA impact treatment rates? Findings in Australia, the UK, and the USA
| Autor: | Sandy Middleton, Dame Caroline Watkins, Elizabeth McInnes, Andrei V. Alexandrov, Elizabeth Lightbody, Anne W. Alexandrov, Victoria Swatzell, Fern Cudlip, Louise E. Craig, Helen Hamilton, Simeon Dale, Dominique A Cadilhac, Sheeba Philip |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
thrombolysis medicine.medical_treatment Computed tomography B700 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Internal medicine Ischaemic stroke medicine survey Recombinant tissue plasminogen activator Original Paper medicine.diagnostic_test business.industry Stroke scale eligibility criteria Thrombolysis Inclusion and exclusion criteria recombinant tissue plasminogen activator Surgery Neurology (clinical) Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Interv Neurol |
| ISSN: | 1664-9737 |
| Popis: | Background: Strict criteria for recombinant tissue plasminogen activator (rtPA) eligibility are stipulated on licences for use in ischaemic stroke; however, practitioners may also add non-standard rtPA criteria. We examined eligibility criteria variation in 3 English-speaking countries including use of non-standard criteria, in relation to rtPA treatment rates. Methods: Surveys were mailed to 566 eligible hospitals in Australia (AUS), the UK, and the USA. Criteria were pre-classified as standard (approved indication and contraindications) or non-standard (approved warning or researcher “decoy”). Percentage for criterion selection was calculated/compared; linear regression was used to assess the association between use of non-standard criteria and rtPA treatment rates, and to identify factors associated with addition of non-standard criteria. Results: Response rates were 74% AUS, 65% UK, and 68% USA; mean rtPA treatment rates were 8.7% AUS, 12.7% UK, and 8.7% USA. Median percentage of non-standard inclusions was 33% (all 3 countries) and included National Institutes of Health Stroke Scale (NIHSS) scores > 4, computed tomography (CT) angiography documented occlusion, and favourable CT perfusion. Median percentage of non-standard exclusions was 25% AUS, 28% UK, and 60% USA, and included depressed consciousness, NIHSS > 25, and use of antihypertensive infusions. No AUS or UK sites selected 100% of standard exclusions. Conclusions: Non-standard criteria for rtPA eligibility were evident in all three countries and could, in part, explain comparably low use of rtPA. Differences in the use of standard criteria may signify practitioner intolerance for those derived from original efficacy studies that are no longer relevant. |
| Databáze: | OpenAIRE |
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