Research Article| Volume 279, ISSUE 1-2, P66-69, April 15, 2009

Increasing number of stroke specialists should contribute to utilization of IV rt-PA: Results of questionnaires from 1466 hospitals in Japan

Published:February 02, 2009DOI:



      To determine the present status of intravenous recombinant tissue plasminogen activator (IV rt-PA) administration in Japan, we investigated the components of stroke case related to IV rt-PA utilization using a questionnaire sent to hospitals.


      Questionnaires about the infrastructure of acute stroke care were sent to 8589 hospitals between August and October 2007. Responses were categorized as follows: 1) stroke service run by stroke physicians (SPs) 24 h/day, 7 days/week (24/7); 2) IV rt-PA utilizable 24/7 (rt-PA hospitals); 3) the total number of SPs. The components related to rt-PA hospitals were analyzed and the significance of the number in SPs to the rt-PA hospital was investigated.


      Responses were received from 4690 (54.7%) of 8569 hospitals. Of these, 1466 hospitals were admitting acute stroke patients. 519 of those hospitals were rt-PA hospitals. Of the 1466 (35.4%), 48.4% were serviced 24/7 by SPs, with 75.2% having <5 SPs. Multivariate analysis revealed administration of rt-PA was significantly associated with >4 SPs (odds ratios (OR), 2.8; 95% confidence interval (95%CI), 1.9–4.1; p<0.001). Compared to hospitals with 0–1 SPs as a reference, the OR for rt-PA utilization was 5.6 (95%CI, 2.5–12.9; p<0.001) with 5 SPs, 10.8 (95%CI, 5.0–23.6; p<0.001) with 6–10 SPs, and 37.3 (95%CI, 6.5–213.1; p<0.001) with >10 SPs.


      An increased number of SPs was associated with increased IV rt-PA utilization. Development of stroke centers with larger numbers of SPs is therefore urgently needed.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kimura K.
        • Minematsu K.
        • Kazui S.
        • Yamaguchi T.
        Mortality and cause of death after hospital discharge in 10,981 patients with ischemic stroke and transient ischemic attack.
        Cerebrovasc Dis. 2005; 19: 171-178
      1. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.
        N Engl J Med. 1995; 333: 1581-1587
        • Yamaguchi T.
        • Mori E.
        • Minematsu K.
        • et al.
        Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT).
        Stroke. 2006; 37: 1810-1815
        • Kleindorfer D.
        • Lindsell C.J.
        • Brass L.
        • Koroshetz W.
        • Broderick J.P.
        National US estimates of recombinant tissue plasminogen activator use: ICD-9 codes substantially underestimate.
        Stroke. 2008; 39: 924-928
        • Kimura K.
        • Kazui S.
        • Minematsu K.
        • Yamaguchi T.
        Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan. A hospital-based prospective registration study.
        Cerebrovasc Dis. 2004; 18: 47-56
        • Alberts M.J.
        • Latchaw R.E.
        • Selman W.R.
        • et al.
        Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition.
        Stroke. 2005; 36: 1597-1616
        • Leira E.C.
        • Lamb D.L.
        • Nugent A.S.
        • et al.
        Feasibility of acute clinical trials during aerial interhospital transfer.
        Stroke. 2006; 37: 2504-2507
        • Schwab S.
        • Vatankhah B.
        • Kukla C.
        • et al.
        Long-term outcome after thrombolysis in telemedical stroke care.
        Neurology. 2007; 69: 898-903
        • Cadilhac D.A.
        • Ibrahim J.
        • Pearce D.C.
        • et al.
        Multicenter comparison of processes of care between Stroke Units and conventional care wards in Australia.
        Stroke. 2004; 35: 1035-1040
        • Alberts M.J.
        • Hademenos G.
        • Latchaw R.E.
        • et al.
        Recommendations for the establishment of primary stroke centers. Brain Attack Coalition.
        Jama. 2000; 283: 3102-3109
        • Launois R.
        • Giroud M.
        • Megnigbeto A.C.
        • et al.
        Estimating the cost-effectiveness of stroke units in France compared with conventional care.
        Stroke. 2004; 35: 770-775
        • Culebras A.
        • Kase C.S.
        • Masdeu J.C.
        • et al.
        Practice guidelines for the use of imaging in transient ischemic attacks and acute stroke. A report of the Stroke Council, American Heart Association.
        Stroke. 1997; 28: 1480-1497
        • Barber P.A.
        • Darby D.G.
        • Desmond P.M.
        • et al.
        Identification of major ischemic change. Diffusion-weighted imaging versus computed tomography.
        Stroke. 1999; 30: 2059-2065
        • Kimura K.
        • Iguchi Y.
        • Yamashita S.
        • Shibazaki K.
        • Kobayashi K.
        • Inoue T.
        Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke.
        J Neurol Sci. 2008; 267: 57-61
        • Kimura K.
        • Iguchi Y.
        • Shibazaki K.
        • et al.
        Recanalization between 1 and 24 hours after t-PA therapy is a strong predictor of cerebral hemorrhage in acute ischemic stroke patients.
        J Neurol Sci. 2008;