The selection of the example of t-PA indication in acute ischemic stroke

In one year before intravenous thrombolysis with tissue plasminogen activator (t-PA) to patients within 3 hours of acute ischemic stroke became an insurance adjustment in Japan, we tried to select the example presumed that it was a t-PA indication. In 264 ischemic stroke and transient ischemic attack (TIA) patients within seven days of stroke onset, patients who arrived within 3 hours were 99 (37.5%) and within 2 hours were 78 (29.5%). It was a tendency that "onset to door" time was short in cardioembolic brain infarction and TIA. In 99 patients who had arrived within 3 hours from stroke onset, aged ≥75 years were 42 (42.4%). Though examples of t-PA indications except the taboo item were 31 (11.7%), the example of indications has decreased to 11(4.2%) when excepting the careful administration item (NIHSS score≥23, JCS≥100 or aged≥75 years old). To improve the effectiveness of t-PA, a further approach on shortening "onset to door" time is important, and additionally the accumulation of cases is also necessary for the establishment of the safety and the effectiveness of t-PA to the elderly patients aged≥75 years old.