In a study that included nearly 60,000 patients with acute ischemic stroke, thrombolytic treatment that was started more rapidly after symptom onset was associated with reduced in-hospital mortality and intracranial hemorrhage, and higher rates of independent walking ability at discharge and discharge to home.
The authors noted that in previous studies, “modest sample sizes have limited characterization of the extent to which onset-to-treatment time influences outcome; and the generalizability of findings to clinical practice [has been]uncertain.”
Jeffrey L. Saver, MD, of the David Geffen School of Medicine at UCLA, and colleagues conducted a study to determine the association between time to treatment with intravenous thrombolysis and outcomes among patients with acute ischemic stroke. The study, published in the June 19 issue of the Journal of the American Medical Association, included data from 58,353 patients with acute ischemic stroke treated with tissue plasimongen activator within 4.5 hours of symptom onset in 1,395 hospitals between April 2003 and March 2012. The patients median age was 72.
The median onset-to-treatment time was 2 hours, 24 minutes. Patient factors most strongly associated with a shorter interval included greater stroke severity, arrival by ambulance and arrival during regular hours.
The researchers found that for every 15-minute-faster interval of tPA therapy, mortality and symptomatic intracranial hemorrhage were less likely to occur, and independence in ambulation at discharge and discharge to home were more likely to occur. For patients treated in the first 90 minutes, compared with 181 to 270 minutes after onset, mortality was 26% less likely to occur, symptomatic intracranial hemorrhage was 28% less likely to occur, independence in ambulation at discharge was 51% more likely to occur and discharge to home was 33% more likely to occur.
“These findings support intensive efforts to accelerate patient presentation and to streamline regional and hospital systems of acute stroke care to compress [onset-to-treatment] times,” the authors wrote.
Read the study abstract: http://jama.jamanetwork.com/article.aspx?articleid=1697967.