Clot Busting Drugs (Thrombolysis) for Acute Ischaemic Stroke in Lothian

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Clot Busting Drugs (Thrombolysis) for Acute
Ischaemic Strokein Lothian
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A cerebral artery blocks with a clot
before after
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Over the next few hours the infarct grows
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Open the blocked artery - reduce the brain damage
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Absolute benefits of aspirin in acute stroke
Treat 100 people for 2 weeks Prevent 1 having a
recurrent stroke
Applicable to 80 of patients
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Absolute benefit of stroke units
Admit 100 patients to SU Prevent about 5 deaths
or bad outcomes
Applicable to 90 of patients
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Absolute harm of clot busters within 3 hrs
Treat 100 patients Cause about 7 significant
bleeds
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Absolute benefit of clot busters within 3 hrs
Treat 100 patients Prevent about 13 bad outcomes
Deliverable to 10 of patients
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Time is brain benefit declines with increasing
delay
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Selecting suitable patients

• Confident clinical diagnosis of stroke
• Severity judged to make risks of treatment
  worthwhile
• Brain imaging compatible with ischaemic stroke
  due to blocked artery
• Patient and/or carer agrees to treatment or trial
  after considering options

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CHSS Stroke Association - public information
campaigns
Coming this autumn!
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Pre hospital services
Training of Ambulance and NHS 24 call
handlers Training Scottish Ambulance Service
Paramedics in Face, Arm, Speech Test
(FAST) Guidelines for GPs out of hours doctors
System for alerting hospital of impending
arrival
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Two alternative models for UK

• Regional stroke centres ambulance triage for ?
  eligible patients
• Increased transfer times
• Delayed access to SU care for majority
• Clot buster in local stroke unit
• Local specialists not available 24/7

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Lothians plan for thrombolysis

• MCN subgroup working with Lothian ambulances to
  ensure patients taken to appropriate hospital
• Hotline to ensure effective triage
• RIE Mon to Thurs 9am 4pm
• St Johns Mon to Fri 9am - 4pm
• WGH 24 / 7
• Thrombolysis Integrated Care Pathway (ICP) for
  each hospital

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Telemedicine
Broadband
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South East Scotland Telemedicine Network

• Seven hospitals
• Telemedicine equipment in each
• Accessed by specialists from office or home
• Provide 24/7 cover in all hospitals

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Thrombolysis service