Objective: To evaluate the factors associated with poor treatment outcomes of acute ischemic stroke after intravenous recombinant tissue plasminogen activator (rt-PA) therapy from 7 hospitals in Northeastern Thailand

Materials and Methods: This study was a retrospective analytical study. Data were obtained from medical records of acute ischemic stroke patients who reached hospital within 4.5 hours after onset and received rt-PA during 2008 May-2012 April.  We evaluated time and process to access hospital, duration of treatment process, and factor associated with good and poor clinical outcomes.

  Results: During the study period, there were 778 patients met the study criteria. Mean onset-to-door time was 1.85 ± 1.05 hours. Previous visiting medical center unavailable for rt-PA made patients delay reaching hospitals (OR 1.62 (95%CI 1.28-2.04), p-value < 0.001). Mean onset-to-needle time was 3.08 ± 1.11 hours. Factors leading to poor outcome were atrial fibrillation (AF) (OR 2.38 (95%CI 1.33-4.23), p-value 0.003) and onset-to-needle time more than 180 minutes (OR 14.78 (95%CI 7.91-27.62), p-value < 0.001).

Conclusions: Patients came to hospital late because of previous visiting to rt-PA-unavailable medical centers. Atrial fibrillation and onset-to-needle time more than 180 minutes associated to poor outcome.

Keywords: poor outcomes, rt-PA, ischemic stroke