Background: Our aim was to investigate the relationship between the number of stroke physicians (SPs) and management of intravenous thrombolysis using recombinant tissue plasminogen activator (IV rt-PA) in Japan. Methods: Questionnaires about the infrastructure of acute-stroke care were sent to 1,466 hospitals that treated acute-stroke patients in September 2007. The responses were categorized as follows: (1) established or ineligible for IV rt-PA before September 2007, and discontinued or starting IV rt-PA from October 2007 to September 2008; (2) total number of SPs in those hospitals; (3) infrastructures according to acute-stroke treatment. Components related to discontinuing or starting IV rt-PA were analyzed. Results: Responses were received from 1,025 hospitals. Of these, 950 hospitals were continuing administration to acute-stroke patients, but 75 had discontinued administration. Before September 2007, 466 hospitals had already established administration of IV rt-PA (rt-PA hospitals) after government approval of IV rt-PA (non-rt-PA hospitals). From October 2007 to September 2008, 45 of 466 rt-PA hospitals (9.7%) discontinued IV rt-PA, while 29 of 479 (6.1%) non-rt-PA hospitals started. Less than 3 SPs were present in 73.9% of the 45 discontinued IV rt-PA hospitals and 37.9% of the 29 starting hospitals. In multivariate analysis, discontinuing IV rt-PA was inversely associated with ≥3 SPs (odds ratio = 0.37; 95% confidence interval = 0.15–0.87; p = 0.023). Factors associated with starting IV rt-PA were ≥3 SPs (OR = 6.19; 95% CI = 2.01–19.08; p = 0.002). Conclusions: The number of SPs available may contribute to the management of rt-PA hospitals.

Keywords:
Thrombolysis, rt-PA, Stroke physician
1.
Kimura K, Minematsu K, Kazui S, Yamaguchi T: Mortality and cause of death after hospital discharge in 10,981 patients with ischemic stroke and transient ischemic attack. Cerebrovasc Dis 2005;19:171–178.
2.
National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1587.
3.
Yamaguchi T, Mori E, Minematsu K, Nakagawara J, Hashi K, Saito I, Shinohara Y: Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan alteplase clinical trial (J-ACT). Stroke 2006;37:1810–1815.
4.
Kleindorfer D, Lindsell CJ, Brass L, Koroshetz W, Broderick JP: National US estimates of recombinant tissue plasminogen activator use: ICD-9 codes substantially underestimate. Stroke 2008;39:924–928.
5.
Sato S, Uehara T, Toyoda K, Yasui N, Hata T, Ueda T, Okada Y, Toyota A, Hasegawa Y, Naritomi H, Minematsu K: Impact of the approval of intravenous recombinant tissue plasminogen activator therapy on the processes of acute stroke management in Japan: The Stroke Unit Multicenter Observational (SUMO) study. Stroke 2009;40:30–34.
6.
Iguchi Y, Kimura K, Shibazaki K, Iwanaga T: Increasing number of stroke specialists should contribute to utilization of IV rt-PA: results of questionnaires from 1466 hospitals in Japan. J Neurol Sci 2009;279:66–69.
7.
Leys D, Ringelstein EB, Kaste M, Hacke W: The main components of stroke unit care: results of a European expert survey. Cerebrovasc Dis 2007;23:344–352.
8.
Minematsu K: Thrombolytic therapy. Rinsho Shinkeigaku 2006;46:840–843.
9.
Conroy MB, Rodriguez SU, Kimmel SE, Kasner SE: Helicopter transfer offers a potential benefit to patients with acute stroke. Stroke 1999;30:2580–2584.
10.
Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, Koroshetz W, Marler JR, Booss J, Zorowitz RD, Croft JB, Magnis E, Mulligan D, Jagoda A, O’Connor R, Cawley CM, Connors JJ, Rose-DeRenzy JA, Emr M, Warren M, Walker MD: Recommendations for comprehensive stroke centers: a consensus statement from the brain attack coalition. Stroke 2005;36:1597–1616.
11.
Leira EC, Lamb DL, Nugent AS, Ahmed A, Grimsman KJ, Clarke WR, Adams HP Jr: Feasibility of acute clinical trials during aerial interhospital transfer. Stroke 2006;37:2504–2507.
12.
Schwab S, Vatankhah B, Kukla C, Hauchwitz M, Bogdahn U, Furst A, Audebert HJ, Horn M: Long-term outcome after thrombolysis in telemedical stroke care. Neurology 2007;69:898–903.
13.
Meyer BC, Raman R, Hemmen T, Obler R, Zivin JA, Rao R, Thomas RG, Lyden PD: Efficacy of site-independent telemedicine in the stroke doc trial: a randomised, blinded, prospective study. Lancet Neurol 2008;7:787–795.
14.
Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF: Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation 2007;115:e478–e534.
15.
Lyden P, Brott T, Tilley B, Welch KM, Mascha EJ, Levine S, Haley EC, Grotta J, Marler J; NINDS TPA stroke study group: Improved reliability of the NIH stroke scale using video training. Stroke 1994;25:2220–2226.
16.
Dewey HM, Donnan GA, Freeman EJ, Sharples CM, Macdonell RA, McNeil JJ, Thrift AG: Interrater reliability of the National Institutes of Health Stroke Scale: rating by neurologists and nurses in a community-based stroke incidence study. Cerebrovasc Dis 1999;9:323–327.
17.
Jorgensen HS, Nakayama H, Raaschou HO, Larsen K, Hubbe P, Olsen TS: The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost: a community-based study. Stroke 1995;26:1178–1182.
18.
Stradling D, Yu W, Langdorf ML, Tsai F, Kostanian V, Hasso AN, Welbourne SJ, Schooley Y, Fisher MJ, Cramer SC: Stroke care delivery before versus after JCAHO stroke center certification. Neurology 2007;68:469–470.
© 2009 S. Karger AG, Basel
2009
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.