Stroke and Cerebrovascular Diseases

Biography

Biography: Tanzida Haque

Abstract

Introduction: Reperfusion therapy with Alteplase has made a dramatic change in the management of acute ischemic stroke. Bleeding is one of the major complications of this therapy. Despite exclusion criteria, patients still bleed as a complication of this medication. Despite clearly agreed guidelines, clinical practice seems to differ widely amongst various practitioners. Several areas of concern identified and attempted to be addressed in the last audit since 2017. Loop closure audit undertaken to assess change in practice to enhance patient care and safety.

Aim: The Loop Closure audit was to establish improvement on areas of previous underperformances, especially sub-optimal BP monitoring and to look additionally at other potential factors that might have contributed to recent concerns on increased incidence of bleed after thrombolysis

Result: Post Thrombolysis BP Management is far from satisfactory with major deficit in standard. Hourly BP monitoring rate has been improved although BP measurement every 15 minutes post thrombolysis period has deteriorated from 85% to 60% . The rate of inappropriate referrals has dropped from 65% to 37%. More than 50% who bled did not have appropriate blood tests done (previously 60%). 60% of thrombolysed patients had NIHSS between 7—16 which shows the trend to have remained unchanged and which is also in keeping with national recommendation. 50% bled between 6-24 hours (previous 30%) and 27% bled after more than 24 hours (previous 55%). Death rate remains high in Post Thrombolysis bleed, around 40%. The mortality rate remains persistently higher.