Changes in European Label and Guideline Adherence After Updated Recommendations for Stroke Thrombolysis: Results From the Safe Implementation of Treatments in Stroke Registry.

Détails

ID Serval
serval:BIB_41F6B3423DA9
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Changes in European Label and Guideline Adherence After Updated Recommendations for Stroke Thrombolysis: Results From the Safe Implementation of Treatments in Stroke Registry.
Périodique
Circulation. Cardiovascular Quality and Outcomes
Auteur(s)
Anani N., Mazya M.V., Bill O., Chen R., Koch S., Ahmed N., Wahlgren N., Prazeres Moreira T.
ISSN
1941-7705 (Electronic)
ISSN-L
1941-7713
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
8
Numéro
6 Suppl 3
Pages
S155-S162
Langue
anglais
Résumé
BACKGROUND: Intravenous thrombolysis (IVT) for acute ischemic stroke is subject to label and guideline contraindications. Updated European guidelines in 2008/2009 recommended IVT in selected patients aged >80 years and stroke onset-to-treatment time 3 to 4.5 hours, which the label still prohibited. Our aim was to compare contraindication nonadherence before and after the guideline update.
METHODS AND RESULTS: Data on IVT-treated patients with stroke at 232 European hospitals participating in the Safe Implementation of Treatments in Stroke registry during both periods 2006 to 2007 (n=6354) and 2010 to 2011 (n=12 046). After the 2008/2009 guideline update, the proportion of patients nonadherent to label increased from 23.6% to 51.1% (P<0.001). Specifically, nonadherence to onset-to-treatment time >3 hours increased from 8.2% to 27.9% and IVT in patients aged >80 years from 8.9% to 17.2% (both P<0.001). Nonadherence also increased to the contraindications severe stroke (National Institutes of Health Stroke Scale score >25), onset-to-treatment time >4.5 hours, blood pressure >185/110 mm Hg, and ongoing oral anticoagulation (all P≤0.001). Higher hospital IVT patient volumes were associated with higher nonadherence rates.
CONCLUSIONS: After the European guideline update, new recommendations were promptly adopted and nonadherence to the unchanged label increased. Label contraindications should be updated.
Mots-clé
Acute Disease, Administration, Intravenous, Aged, 80 and over, Brain Ischemia/drug therapy, Clinical Trials as Topic, Europe, Guideline Adherence, Hospitals, High-Volume, Humans, Practice Guidelines as Topic, Registries, Stroke/drug therapy, Thrombolytic Therapy, Time-to-Treatment, Tissue Plasminogen Activator/contraindications, Tissue Plasminogen Activator/therapeutic use
Pubmed
Web of science
Open Access
Oui
Création de la notice
05/04/2016 18:23
Dernière modification de la notice
08/05/2019 17:42
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