World-class stroke care in Australia

Associate Professor Helen Dewey, Head of the Inpatient Stroke Service at Austin Health, Melbourne, and co-authors report Australian outcomes from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register (SITS-ISTR).

They compared data for 581 Australian patients and 20,953 patients worldwide who were treated with recombinant tissue plasminogen activator (rt-PA) for acute stroke.

Prof Dewey said that, despite Australian patients being older, less independent before the stroke, more likely to be taking aspirin and anti-hypertensives before the stroke, and having a higher incidence of comorbidities, there was no statistically significant difference in the proportion of patients with post-treatment symptomatic intracerebral haemorrhage (ICH) between the two cohorts.

“This finding is reassuring because symptomatic ICH is the most feared complication of rt-PA therapy,” Prof Dewey said.

Although the study showed poorer functional outcomes in older patients treated with rt-PA compared with their younger counterparts, Prof Dewey said the data suggested that older patients were not at increased risk of harm after rt-PA, which might help to inform treatment decisions.

She said that the study supported the ongoing use of rt-PA for treatment of acute ischaemic stroke in Australian specialist stroke centres.

“We also encourage newer centres that are not yet treating with rt-PA to develop ways of doing so, to improve stroke treatment in accordance with current evidence,” she said.

In an accompanying editorial, Prof Richard Gerraty, neurologist and Professor of Medicine at Monash University, Melbourne, and Associate Professor Mark Fitzgerald, Emergency Medicine Physician and Director of Trauma Services at The Alfred Hospital, Melbourne, write that the important safety data in the study are reassuring.

“Australian registry data provide reassurance that Australian stroke physicians, emergency physicians and systems that support thrombolysis can achieve similar results to those recorded in Europe,” Prof Gerraty said.

“We can now move beyond discussing the efficacy and feasibility of implementing this therapy and work toward a more coordinated system of applying the evidence.”

The Medical Journal of Australia is a publication of the Australian Medical Association.

 

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The statements or opinions that are expressed in the MJA  reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.

 

CONTACT:      A/Prof Helen Dewey                            0420 907 010

                     Ms Tessa Young                                03 9496 6671 / 0437 255 797

                     Corporate Communications Consultant, Austin Health

 

                     Prof Richard Gerraty                           0407 090 095

                     Mr Brendan Carroll                             9076 3459

                     Alfred Public Affairs

                     Ms Colleen Coghlan                           0423 777 452

                     Media Manager - Epworth HealthCare