Conflict of interest: None declared.
Patient refusal of thrombolytic therapy for suspected acute ischemic stroke
Article first published online: 11 DEC 2012
© 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization
International Journal of Stroke
How to Cite
Vahidy, F. S., Rahbar, M. H., Lal, A. P., Grotta, J. C. and Savitz, S. I. (2012), Patient refusal of thrombolytic therapy for suspected acute ischemic stroke. International Journal of Stroke. doi: 10.1111/j.1747-4949.2012.00945.x
Statistical Analysis performed by: Vahidy FS1 and Rahbar MH2,3
This work was supported by grants from the Howard Hughes Medical Institute (to SIS), and the National Institute of Health (P50 SPOTRIAS).
Search Terms: All Cerebrovascular Disease/Stroke , Professional Conduct and Ethics , Outcome Research 
- Article first published online: 11 DEC 2012
- the Howard Hughes Medical Institute (to SIS)
- the National Institute of Health. Grant Number: P50 SPOTRIAS
- Keywords: acute stroke therapy;
- ischemic stroke;
To determine factors associated with patients refusing IV t-PA for suspected acute ischemic stroke (AIS), and to compare the outcomes of patients who refused t-PA (RT) with those treated with t-PA.
Patients who were treated with and refused t-PA at our stroke center were identified retrospectively. Demographics, clinical presentation, and outcome measures were collected and compared. Clinical outcome was defined as excellent (mRS: 0–1), good (mRS: 0–2), and poor (mRS: 3–6).
Over 7·5 years, 30 (4·2%) patients refused t-PA. There were no demographic differences between the treated and RT groups. The rate of RT decreased over time (OR 0·63, 95% CI 0·50–0·79). Factors associated with refusal included a later symptom onset to emergency department presentation time (OR 1·02, 95% CI 1·01–1·03), lower NIHSS (OR 1·11, 95% CI 1·03–1·18), a higher proportion of stroke mimics (OR 17·61, 95% CI 6·20–50·02) and shorter hospital stay (OR 1·32, 95% CI 1·09–1·61). Among patients who were subsequently diagnosed with ischemic stroke, only length of stay was significantly shorter for refusal patients (OR 1·37, 95% CI 1·06–1·78). After controlling for mild strokes and stroke mimics, clinical outcome was not different between the groups (OR 1·61, 95% CI 0·69–3·73).
The incidence of patients refusing t-PA has decreased over time, yet it may be a cause for t-PA under-utilization. Patients with milder symptoms were more likely to refuse t-PA. Refusal patients presented later to the hospital and had shorter hospital stays. One out of six refusal patients (16·6%) had a stroke mimic.