Comparing the administration of rt-PA among stroke fast track patients who arrived by emergency medical services and non-emergency medical services.
The Medical journal of Malaysia · 2026-01-01 · Observational study
Abstract
INTRODUCTION: Stroke is a leading cause of death and disability worldwide. Prompt treatment with recombinant tissue plasminogen activator (rt-PA) and endovascular therapy improves outcomes in acute ischemic stroke. Although Emergency Medical Services (EMS) facilitate timely treatment. This study compared rt-PA administration rates and clinical outcomes between patients who arrived via EMS and those who did not in Mueang District, Chachoengsao Province. MATERIALS AND METHODS: A retrospective descriptive study was conducted from January 2021 to January 2024, including patients presenting within 4.5 hours of onset, without inter-hospital transfer, and completing 90-day follow-up. Data included transport mode, treatment times, and outcomes. RESULTS: Of 103 patients, 28 (27.2%) arrived by EMS and 75 (72.8%) by non-EMS. Lipid-lowering agent use was less frequent in the EMS group (17.9% vs. 46.7%, p = 0.008). Onset-to-hospital, door-to-needle, and onset-to-needle times showed no significant differences, and rt-PA administration rates were comparable. In univariable analysis, EMS patients had a higher median NIHSS score than non-EMS patients (median difference = 6.00, 95% CI: 0.99-11.01, p = 0.019), but this was not significant in multivariable analysis (median difference = 0.45, 95% CI: -1.99 - 2.84, p = 0.706). rt-PA was administered in 53.6% of EMS patients and 38.7% of non- EMS patients (p = 0.174). Mechanical thrombectomy was performed more often in EMS patients (42.9% vs. 22.7%, p = 0.043). Discharge NIHSS and 90-day mRS did not differ significantly. CONCLUSION: EMS use was associated with greater thrombectomy referral but not with higher rt-PA administration rates or improved outcomes.
Tags
Antithrombotics & thrombolytics · Mortality & survival · Thrombolytics