Earlier thrombolysis tied to long term survival in ischemic stroke: JAMA
Researchers have found that earlier administration of thrombolysis in ischemic stroke reduces mortality and readmissions upto one year.The study published in the Journal of American Medical Association have revealed that shorter door-to-needle times for administering tissue plasminogen activator (tPA) to stroke patients are associated with lower rates of mortality and readmissions at 1 year.These findings support efforts to shorten time to thrombolytic therapy.
According to studies in the past, earlier administration of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke is associated with reduced mortality by the time of hospital discharge and better functional outcomes at 3 months. However, it remains unclear whether shorter door-to-needle times translate into better long-term outcomes.
The researchers conducted a study to examine whether shorter door-to-needle times with intravenous tPA for acute ischemic stroke are associated with improved long-term outcomes.
This retrospective cohort study included Medicare beneficiaries aged 65 years or older who were treated for acute ischemic stroke with intravenous tPA within 4.5 hours from the time they were last known to be well at Get With The Guidelines–Stroke participating hospitals between January 1, 2006, and December 31, 2016, with 1-year follow-up through December 31, 2017.In the study the researchers identified over 55,000 Medicare beneficiaries who were treated with tPA for acute ischemic stroke within 4.5 hours of symptom onset.
They found that patients with acute ischemic stroke treated with intravenous tissue plasminogen activator, longer door-to-needle times (within 90 minutes after hospital arrival) were significantly associated with higher all-cause mortality at 1 year (hazard ratio per 15-minute increase in time, 1.04) and higher likelihood of all-cause readmission at 1 year (hazard ratio per 15-minute increase in time, 1.02).
In addition to this the patients given tPA within 45 minutes of hospital arrival (so-called door-to-needle time) had lower all-cause mortality (31% vs. 35%) and lower all-cause readmission (38% vs. 41%) at 1 year than those given tPA after 45 minutes. Similar results were seen when a 60-minute cutoff was used.
The researchers concluded that among patients aged 65 years or older with acute ischemic stroke who were treated with tissue plasminogen activator, shorter door-to-needle times were associated with lower all-cause mortality and lower all-cause readmission at 1 year. These findings support efforts to shorten time to thrombolytic therapy.
The findings may motivate and exhort health systems to design stroke services that can treat patients with acute ischemic stroke with thrombolytic therapy in a rapid fashion for better outcomes on long term basis.
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JAMA. 2020;323(21):2170-2184. rel="nofollow">doi:10.1001/jama.2020.5697