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Patients Do Better at Hospitals That Follow Stroke Guidelines
Date:2/22/2010

n the use of evidence-based therapies, large variations between different hospitals and different physicians, and disparities in the use of recognized therapies," Fonarow explained. "There were certain patients -- including older patients, women and minorities -- who were less likely to receive recommended therapy."

The recommended steps include:

  • Giving clot-dissolving medication, or intravenous recombinant tissue plasminogen activator (tPA) three hours from the onset of symptoms for those with ischemic stroke.
  • Giving anti-platelet or anticoagulant medication within 48 hours of admission and at discharge.
  • Providing treatments to prevent deep vein thrombosis by the end of day two.
  • Giving patients with atrial fibrillation anticoagulation medications such as Coumadin (warfarin) at discharge.
  • Providing cholesterol-lowering medications such as statins to help prevent additional strokes or heart attacks.
  • Provide smokers with information on smoking cessation.

Additional measures include making sure CT scans get done quickly; offering stroke education to patients and caregivers, including information about prevention and warning signs of stroke; referrals for stroke rehabilitation and screening for swallowing problems.

Since 2003, nearly 1,400 hospitals of the nation's approximately 5,000 community hospitals have pledged to follow the protocols and enter their data into a national registry. Between 2003 and 2009, the percentage of stroke or TIA patients who received all of the recommended treatments increased from 44 percent to 84 percent, while those who received nearly all increased from 72 percent to 93 percent, the researchers reported.

Patients average age was about 72. About 60 percent had an ischemic stroke, which occurs when a blood clot blocks a blood vessel in the brain; nearly 23 percent had a TIA; nearly 11 percent had an intracerebral hemorrhage;
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