Earlier Thrombolytic Therapy Tied to Better All-Cause Stroke
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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.

This study aimed to examine whether shorter door-to-needle times with intravenous tPA for acute ischemic stroke are associated with improved long-term outcomes.

Results: Among the 61426 patients treated with tPA within 4.5 hours, the median age was 80 years and 43.5% were male. The median door-to-needle time was 65 minutes. The 48666 patients who were treated with tPA and had door-to-needle times of longer than 45 minutes, compared with those treated within 45 minutes, had significantly higher all-cause mortality, higher all-cause readmission, and higher all-cause mortality or readmission.

The 34367 patients who were treated with tPA and had door-to-needle times of longer than 60 minutes, compared with those treated within 60 minutes, had significantly higher all-causone mortality, higher all-cause readmission, and higher all-cause mortality or readmission.

Every 15-minute increase in door-to-needle times was significantly associated with higher all-cause mortality within 90 minutes after hospital arrival, but not after 90 minutes, higher all-cause readmission, and higher all-cause mortality or readmission.

Conclusively, 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.

Source: https://jamanetwork.com/journals/jama/article-abstract/2766633?widget=personalizedcontent&previousarticle=2766614
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