Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: a systematic review of the literature

Sharobeam, Angelos; Jones, Brett; Walton-Sonda, Dianne; Lueck, Christian J.

doi:10.1007/s00415-020-09803-6

Cited by 32 publications

(31 citation statements)

References 156 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the United States, <25% of eligible stroke patients arrive in the emergency department within 3 h of treatment, while in China, only ~20% of the patients can reach the emergency department within 3 h of onset (8,12). The effective measures to reduce the delay of stroke treatment include rapid stroke identification, rapid stroke transport, high efficiency treatment in hospital, and high cooperation between patients and their families (13,14). With the construction of senior stroke center in China, hospital treatment and rapid transportation have been constantly improved, the rapid identification of stroke and the cooperation of patients still need continuous improvement.…”

Section: Discussionmentioning

confidence: 99%

“…The rapid identification of stroke by primary medical staff and 120 medical staff enables the key factors to ensure the rapid transport of patients. The recognition of early warning signs of stroke by the public is still low, and there are great differences in sex, age, race and living area (14)(15)(16)(17). Studies worldwide have found that educational intervention can improve public recognition of stroke.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of multi-level stroke education on treatment and prognosis of acute ischemic stroke

et al. 2020

View full text Add to dashboard Cite

This observational study aimed at the significance of multi-level education in the treatment and prognosis of acute ischemic stroke. Multi-level stroke education was carried out among residents and medical staff for one year in Guancheng district. After 1 year, 519 patients with acute ischemic stroke admitted to The First People's Hospital of Zhengzhou were invited to the study, 272 patients from the Guancheng district were divided into the experimental group, and 247 patients who were not from the Guancheng district but in the neighborhood of The First People's Hospital of Zhengzhou were divided into the control group. Statistical methods were applied to analyze the degree of awareness of stroke, the time from onset to hospital, the route to hospital, the number of patients coming to the hospital within 4.5 h, the number of intravenous thrombolysis, door-to-needle time (DNT), modified Rankin scale (MRS) score, and the number of hemorrhagic transformation cases. After one year of multi-level systematic stroke education, there were significant differences in stroke awareness between the experimental group and the control group in terms of limb weakness (87.87 vs. 62.75%), speech inarticulation (78.3 vs. 55.06%), facial paralysis (69.12 vs. 38.06%), limb numbness (57.35 vs. 29.15%), consciousness disorder (62.50 vs. 42.11%), walking instability with severe dizziness (39.97 vs. 15.79%) (P<0.05). There was no statistical significant difference in unclear vision or blind eyes or severe headache (P>0.05). There were statistical differences between the two groups in the time from the onset to the hospital (14.82±17.67 vs. 25.92±25.23), emergency medical services (EMS) (36.02 vs. 16.19%), number of patients coming to the hospital within 4.5 h (67 vs. 32), venous thrombolysis cases (55 vs. 17), DNT time (42.43±17.30 vs. 63.35±26.53), hemorrhagic transformation cases (11 vs. 21), and MRS score grade ≥2 (230 vs. 169) (P<0.05). Multi-level education can effectively improve the patient's awareness of stroke, encourage more patients to use EMS system to the hospital. More patients were aware that they should reach the hospital within 4.5 h. It helps shorten DNT time and give more patients the opportunity to receive intravenous thrombolysis or intravascular thrombectomy, which may improve the prognosis and reduce hemorrhagic transformation without reducing mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of multi-level stroke education on treatment and prognosis of acute ischemic stroke

et al. 2020

View full text Add to dashboard Cite

show abstract

“…However, this treatment is time dependent and delay in thrombolysis injection reduces its effectiveness. Consequently timely intravenous thrombolysis for acute ischemic stroke is a main concern in health care system (3).…”

Section: Introductionmentioning

confidence: 99%

Prehospital notification reduced time delays but not neurological outcomes in acute ischemic stroke

Sangari¹,

Akhoundzadeh²,

Vahedian³

2021

Preprint

View full text Add to dashboard Cite

Introduction: Since timely thrombolytic therapy is a crucial variable in acute ischemic stroke recovery, health care systems are trying to find new interventions to reduce treatment delay in order to improve neurological function. In Iran, SAMA code as a prehospital notification plan has been developed to help emergent stroke treatment. This study aimed to compare time delay to thrombolysis therapy and neurological outcomes between prehospital notification (SAMA)-transported patients and self-transported patients in acute ischemic stroke.Methods and materials: In this retrospective cohort study, the data of 185 stroke patients treated with intravenous thrombolysis were gathered. There were two groups including, SAMA-transported (n=110) patients and self-transported (n=75) patients. The treatment delays including, onset to needle time (ONT), onset to door time, (ODT), door to CT time (DCT) and door to needle time (DNT) as well the neurological scores measured using NIHSS and mRS were analyzed between two groups. p-value<0.05 was considered as significant.Results: The results showed that delay times reduced in SAMA-transported patient compared to that in self-transported patients. The findings revealed a significant difference in ONT (150 (120-180) vs 180 (150-225) (p=0.001), DNT (80 (60-105) vs 100 (80-125) (p=0.0001), and DCT (27 (20-37) vs 36 (24-52) (p=0.001) between SAMA-transported patients and self-transported patients. The times are represented as minute (median and IQR). However, there was no significant difference between two groups in terms of neurologic deficit severity. Also, there was no relationship between the delay time and neurological outcomes. Conclusion: Although SAMA prehospital notification could partially reduce treatment delay times in acute ischemic stroke, such reduction was not enough to impact on neurologic deficit recovery. It seems more reduction in delay time is needed to significant improvement of neurological dysfunctions.

show abstract

“…Brain cells die rapidly after stroke; therefore, therapeutic treatment needs to be administered early. The ‘time–outcome’ effect is highly important in stroke monitoring [ 24 , 25 , 26 , 27 ] due to the association of time delays with worse patient outcomes [ 28 , 29 , 30 ]. The most common modality for evaluation of suspected stroke patients is magnetic resonance imaging (MRI) or computed tomography (CT), which are mainly used to exclude intra-cerebral hemorrhage but have poor sensitivity for detecting acute ischemia.…”

Section: Introductionmentioning

confidence: 99%

B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor

et al. 2020

View full text Add to dashboard Cite

Stroke is a widespread condition that causes 7 million deaths globally. Survivors suffer from a range of disabilities that affect their everyday life. It is a complex condition and there is a need to monitor the different signals that are associated with it. Stroke patients need to be rapidly diagnosed in the emergency department in order to allow the admission of the time-limited treatment of tissue plasminogen activator (tPA). Stroke diagnostics show the use of sophisticated technologies; however, they still contain limitations. The hidden information and technological advancements behind the utilization of biomarkers for stroke triaging are significant. Stroke biomarkers can revolutionize the way stroke patients are diagnosed, monitored, and how they recover. Different biomarkers indicate different cascades and exhibit unique expression patterns which are connected to certain pathologies in the human body. Over the past decades, B-type natriuretic peptide (BNP) and its derivative N-terminal fragment (NT-proBNP) have been increasingly investigated and highlighted as significant cardiovascular biomarkers. This work reviews the recent studies that have reported on the usefulness of BNP and NT-proBNP for stroke triaging. Their classification association is also presented, with increased mortality in stroke, correlation with cardioembolic stroke, and an indication of a second stroke recurrence. Moreover, recent scientific efforts conducted for the technological advancement of a bedside point-of-care (POC) device for BNP and NT-proBNP measurements are discussed. The conclusions presented in this review may hopefully assist in the major efforts that are currently being conducted in order to improve the care of stroke patients.

show abstract

Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: a systematic review of the literature

Cited by 32 publications

References 156 publications

Effect of multi-level stroke education on treatment and prognosis of acute ischemic stroke

Effect of multi-level stroke education on treatment and prognosis of acute ischemic stroke

Prehospital notification reduced time delays but not neurological outcomes in acute ischemic stroke

B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor

Contact Info

Product

Resources

About