The multinational Safe Implementation of Thrombolysis in
Stroke-Monitoring Study (
SITS-MOST) was an observational study to assess the safety and efficacy of
thrombolytic therapy, when administered within the first 3 h after onset of
ischaemic stroke.
SITS-MOST was embedded within the Safe Implementation of Thrombolysis in
Stroke-International
Stroke Thrombolysis Register (
SITS-ISTR), an internet-based, international monitoring registry for auditing the safety and efficacy of routine
therapeutic use of thrombolysis in acute
ischaemic stroke. We performed an analysis of data contributed to
SITS-MOST and
SITS-ISTR from UK centres.
RESULTS: A total of 614 patients received thrombolysis for
stroke between December 2002 and April 2006, 327 were registered to
SITS-MOST and 287 to
SITS-ISTR. Thirty-one centres treated patients in the UK, of which 23 registered patients in both
SITS-MOST and
SITS-ISTR and eight solely to
SITS-ISTR. The median age from the UK
SITS-MOST was identical to the non-UK
SITS-MOST register: 68 years (IQR 59-75). The majority (96.1%) of patients from the UK were treated between 8.00 a.m. and 9.00 p.m., and only 18.4% were treated on weekend days, reflecting the difficulties of maintaining provision of a thrombolytic service out of hours. Median onset-to-treatment-time was 155 min (IQR 130-170 min) for the UK, compared to 140 min (IQR 114-165 min) for the non-UK
SITS-MOST group (P < 0.001). UK
SITS-MOST patients at baseline had more severe
stroke in comparison with non-UK patients [median NIHSS 14.5 (IQR 9-19) vs. 12 (IQR 8-17) (P < 0.001)]. Forty-eight percent of UK patients achieved mRS of 0-2 (independence), compared to 55% of the non-UK
SITS-MOST register. There was no significant difference in symptomatic intracerebral haemorrhage rate in the UK compared with the non-UK
SITS-MOST patients [2.5% (95% CI 1.3-4.8) vs. 1.7% (95% CI 1.4-2.0) P = 0.28]. In the multivariate analysis, there was no statistically significant difference in any outcome between UK and non-UK
SITS-MOST patients.
CONCLUSION:
Thrombolytic therapy for
stroke has been implemented successfully at a small number of UK
stroke centres, with patchy provision throughout the country. The low frequency of treatment out with office hours suggests deficient infrastructure to support delivery. UK patients tended to be more severely affected at baseline and to be treated later. Outcomes are comparable to those seen at the non-UK
SITS centres.