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

Abstract

BACKGROUND AND PURPOSE: The Ministry of Health, Labor, and Welfare of Japan approved the use of recombinant tissue-type plasminogen activator (rt-PA) for the treatment of acute ischemic stroke in October 2005. The impact of the regulatory approval of rt-PA on the processes of acute stroke management was examined. METHODS: A prospective, multicenter, observational study was conducted between December 2004 and December 2005 in 84 Japanese institutes, including 24 institutes with a stroke unit. We enrolled 4620 consecutive patients who were hospitalized within 72 hours after the onset of completed ischemic stroke; 1089 of them were hospitalized after rt-PA was approved. The patients' characteristics and the processes of stroke management were compared before and after rt-PA approval. RESULTS: Age, gender, stroke subtype, time from onset to hospital visit, and National Institutes of Health Stroke Scale score on admission were similar between the 2 periods. With approval, the percentage of patients treated with intravenous rt-PA therapy increased from 0.7% to 2.6% (P<0.001). The rate increased from 0.9% to 5.2% in institutes with a stroke unit (P<0.001) but did not increase in other institutes (P≤0.587). Within 24 hours of stroke onset, conventional MRI (P≤0.003), diffusion-weighted MRI (P<0.001), magnetic resonance angiography (P≤0.001), carotid ultrasound (P≤0.004), measurement of prothrombin time or activated partial thromboplastin time (P≤0.034), and measurement of blood sugar (P≤0.015) were performed more frequently after rt-PA approval. CONCLUSIONS: The present results indicate that the approval of intravenous rt-PA therapy resulted in dramatic changes in the processes of management for acute stroke patients. Copyright © 2009 American Heart Association. All rights reserved.