Background
As randomised controlled trials have shown improved outcomes in selected patients following thrombolysis in the extended time window (9 hours from last seen well, or 9 hours from mid-point of sleep) (1, 2), treatment of these patients is now a “strong recommendation” in the Australia and NZ Living Stroke Guidelines (3). We carried out an audit to look at the potential impact of this recommendation in Waikato Hospital.
Methods
List of patients diagnosed with acute stroke between May to July 2023 was retrieved by clinical coding. Information such as modified Rankin score (mRS), National Institutes of Health Stroke Score (NIHSS), and management of stroke were collected.
Results
There were a total of 137 acute strokes of which 107 were ischaemic, with 12 presenting within the extended time window. Four patients had unfavourable imaging findings, and four patients had low NIHSS. Two patients receiving clot retrieval also met criteria for extended window thrombolysis. There were also two patients that did not proceed with CT angiogram and perfusion (CTA/P) scan, but they may have met criteria for extended window thrombolysis depending on imaging results.
Conclusion
This audit showed that in the 3-month period, two more patients might have had thrombolysis. An additional two patients would have proceeded to CTA/P and might have been eligible depending on imaging findings. This will likely impact on the workload for the Medical, Radiology and Emergency Department team. There is now a project to update local thrombolysis protocols in Waikato Hospital.