Objective: To report experience with the use of intravenous tissue plasminogen activator (alteplase) to treat acute ischaemic stroke (AIS) at an Australian outer Metropolitan Hospital.

Design: Prospective audit of patients and records from hospital database.

Participants and setting: All patients with AIS treated with alteplase between 15/02 and 09/2007 at the Frankston Hospital, Victoria.

Main outcome measures: Times from stroke onset to arrival at the emergency department and treatment; rates of symptomatic intracerebral haemorrhage (ICH); clinical outcome at 30 days and 3 months; violations of treatment protocol.

Results: Of 408 patients admitted with AIS, 12 (2.9%) were treated with alteplase. Median time from stroke onset to alteplase treatment was 2 h 20 minutes, and median door-to-needle (DN) was 77 minutes with 4 of 12 patients achieving the recommended 60 minutes. Of 11 patients 6 (55%) had excellent clinical outcomes at 30 day follow-up (modified Rankin Score. 0-1), and 8 (72%) were functionally independent (score, 0-2). The 90 day favourable outcome was 57%. Mortality rate was 16%, with one patient dying of an extended infarct and the other due to pulmonary embolism. One patient (8%) had a non fatal symptomatic ICH. Treatment deviated from the protocol as two patients (16%), received alteplase bolus after 5 minutes of infusion.

Conclusion: With the low incidence of symptomatic ICH, these data supports that alteplase is safe and effective in routine clinical use when used within 3 h of stroke onset, even by a centre with little clinical experience of thrombolytic therapy for acute stroke.