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Stroke: Time is the brain: Stroke, the shorter the hospital admission-thrombolysis time, the prognosis is significantly improved

 Last Update: 2022-01-08
 Source: Internet
 Author: User

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Intravenous TPA (tissue-type plasma protein activator) is still the only medical reperfusion therapy to improve the prognosis of patients with acute ischemic stroke , and its benefit is highly related to time
.

Stroke

The US National Guidelines set door-to-needle (DTN, admission to thrombolysis) goals, but historically, these goals are usually not achieved in routine practice
.

Goal

Plan for the first and second stages of stroke
.

In addition, clinical results were evaluated, including mortality, symptomatic intracranial hemorrhage, discharge destination, functional results at discharge, and overall TPA usage before and after the implementation of the "Target: Stroke" program in the first two phases

Among the 154 221 patients who received tPA within 3 hours of the onset of stroke symptoms (median age 72 years, 50.

1% women), the median DTN time was 78 minutes before the intervention (interquartile range, 60-98) Reduced to 66 minutes (51-87) in the first stage, and 50 minutes (37-66) in the second stage (P<0.
001)

The proportion of patients with DTN ≤ 60 minutes increased from 26.

4% to 42.
7% to 68.
6% (P<0.
001)

Compared with the pre-intervention, the hospitals in the second intervention (2014-2018) achieved a higher TPA usage rate (11.
7% vs.
5.
6%; adjusted odds ratio, 2.
43[95%CI, 2.
31-2.
56]) , The hospital mortality rate is lower (6.
0% vs.
10.
0%; adjusted odds ratio, 0.
69 [0.
64-0.
73]), and fewer bleeding complications (3.
4% vs.
5.
5%; adjusted odds ratio, 0.
68[ 0.
62-0.
74]), and a higher rate of discharge home (49.
6% vs.
35.
7%; adjusted odds ratio, 1.
43[1.
38-1.
50])
.

Similar results were found in a sensitivity analysis of 18,501 patients who received TPA within 4.
5 hours of the onset of symptoms
.

The important significance of this study is that the timeliness of the start of thrombolytic therapy is greatly improved, and the increase in thrombolytic therapy is related to the improvement of clinical results
.

Original Source:

The timeliness of initiation of thrombolytic therapy is greatly improved, and the increase in thrombolytic therapy is related to the improvement of clinical results
.
Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention.
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