Intravenous Thrombolysis for Acute Cerebral Ischaemia: Comparison of Outcomes between Patients Treated at Working versus Nonworking Hours

Bodenant, Marie; Leys, Didier; Debette, Stéphanie; Cordonnier, Charlotte; Dumont, Frédéric; Hénon, Hilde; Girot, Marie; Lucas, Christian; Devos, David; Defebvre, Luc; Deplanque, Dominique; Leclerc, Xavier; Bordet, Régis

doi:10.1159/000316058

Cited by 33 publications

(29 citation statements)

References 51 publications

(41 reference statements)

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“…Patients' characteristics were mostly homogeneous across all the subgroups, particularly, as previously reported, 23,28 with regard to the median baseline stroke severity. There is the exception for some, more statistically than clinically, significant differences, probably related to the large sample size that allows the detection of even small imbalances.…”

Section: Discussionsupporting

confidence: 60%

“…Hence, it is urgent to understand whether the access to thrombolytic treatment is always guaranteed, and with the same safety and efficacy, irrespective of time and day of treatment. Few recent studies on this issue found controversial results, 16,[23][24][25][26][27][28][29] one reporting higher case fatality rates in patients treated during working hours, 23 whereas another reporting that diurnal IV tissue-type plasminogen activator (t-PA) administration was independently associated with early recanalization and better 90-day functional outcome. 24 Other studies showed that the majority of patients with stroke received thrombolysis during nonworking hours and that time of hospital admission was not an independent predictor of outcome.…”

mentioning

confidence: 99%

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Within-Day and Weekly Variations of Thrombolysis in Acute Ischemic Stroke

Lorenzano

Ahmed

Tatlısumak

et al. 2014

Stroke

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For each subgroup, we analyzed frequency of thrombolytic treatments, time intervals, and outcomes (3-month modified Rankin Scale score 0-2 as good functional outcome, mortality, symptomatic intracerebral hemorrhage). Results-We included 21 513 patients. Considering the mean expected number of patients treated per hour (0.4) and per day of the week (9.8), if no temporal variations were present, patients were significantly treated more during day hours and weekdays (P<0.0001). Median door-to-needle and onset-to-treatment times were longer for patients treated during night hours and on weekends (P<0.01). After adjustment for confounding variables, treatment during day hours was an independent predictor of good functional outcome (odds ratio, 1.12; 95% confidence interval, 1.04-1.21; P=0.004), and patients treated during weekdays were at risk of higher mortality (odds ratio, 1.15; 95% confidence interval, 1.04-1.28; P=0.008). Conclusions-Frequency of thrombolytic treatment seems to follow the same circadian pattern of stroke incidence, whereas its correspondence to a weekly pattern is less clear. Time of treatment is an independent predictor of outcome. (Stroke. 2014;45:176-184.)

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Section: Discussionsupporting

confidence: 60%

mentioning

confidence: 99%

Within-Day and Weekly Variations of Thrombolysis in Acute Ischemic Stroke

Lorenzano

Ahmed

Tatlısumak

et al. 2014

Stroke

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“…A recent MRI study further indicated that the use of MRI-based thrombolysis may be safer compared with CT-based thrombolysis, but further studies are needed to support these results. 20 So far, only Bodenant et al 13 focused on stroke patients receiving thrombolysis during working or nonworking hours like we did. Compared with the Charité cohort, the cohort reported by Bodenant et al received thrombolysis almost exclusively according to CT data, 13 as done similarly within the TEMPiS project.…”

Section: Discussionmentioning

confidence: 89%

“…20 So far, only Bodenant et al 13 focused on stroke patients receiving thrombolysis during working or nonworking hours like we did. Compared with the Charité cohort, the cohort reported by Bodenant et al received thrombolysis almost exclusively according to CT data, 13 as done similarly within the TEMPiS project. Nevertheless, even within the TEMPiS cohort, we did not observe a significant impact of hospital admission time (Table 3), as described by Bodenant et al in a much smaller cohort.…”

Section: Discussionmentioning

confidence: 89%

“…Surprisingly, the data from a French university hospital stroke unit discovered increased 7-day mortality (odds ratio [OR]ϭ3.6; 95% CI, 1.2 to 10.4) in patients receiving thrombolysis during working hours, without providing a sufficient explanation. 13 To assess the impact of thrombolysis during working versus nonworking hours on 7-day mortality, the occurrence of symptomatic intracranial bleeding (sICH), and clinical worsening, we used data from stroke patients treated either at the University Hospital Charité Berlin (Charité) or within a German telestroke project, the Telemedical Project of Integrated Stroke Care (TEMPiS).…”

mentioning

confidence: 99%

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Impact of Hospital Admission During Nonworking Hours on Patient Outcomes After Thrombolysis for Stroke

Hæusler

Gerischer

Vatankhah

et al. 2011

Stroke

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Background and Purpose-Whether the time of hospital admission is relevant for short-term outcome after stroke is under debate and may depend on care facilities. Methods-We retrospectively analyzed medical records from patients who received thrombolytic therapy within 4.5 hours of stroke onset in a stroke unit of the Charité-University Hospital Berlin (Charité; nϭ291) or within the stroke telemedicine (TEMPiS) network, comprising 12 community hospitals with telestroke units in Bavaria (nϭ616). Results-Thrombolytic therapy was administered during nonworking hours in 59.5% (Charité) and 55.0% (TEMPiS) of patients. A trend toward a lower rate of symptomatic intracranial hemorrhage (3.4% versus 9.2%; Pϭ0.053), clinical worsening (11.9% versus 19.7%; Pϭ0.079), and 7-day mortality (3.4% versus 8.7%; Pϭ0.073) after admission during working hours was seen at Charité. However, multivariable analysis did not show a significant impact of the time of admission on clinical worsening, symptomatic intracranial hemorrhage, or 7-day mortality in both cohorts. Thrombolysis based on brain computed tomography instead of magnetic resonance imaging (odds ratioϭ4.98, 95% CI, 1.09 to 22.7) and more severe National Institutes of Health Stroke Scale score on admission (odds ratioϭ1.15 per point; 95% CI, 1.07 to 1.24) were associated with 7-day mortality at Charité. National Institutes of Health Stroke Scale score on admission (odds ratioϭ1.13 per point; 95% CI, 1.06 to 1.19) and older age (odds ratioϭ1.05 per year; 95% CI, 1.004 to 1.09) were correlated with 7-day mortality in TEMPiS. National Institutes of Health Stroke Scale on admission was the only independent predictor of symptomatic intracranial hemorrhage or clinical worsening in both cohorts. Conclusions-The majority of stroke patients received thrombolysis during nonworking hours. The time of hospital admission did not significantly influence the short-term outcome after thrombolysis. (Stroke. 2011;42:2521-2525.)

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Intravenous thrombolysis for acute cerebral ischaemia in old stroke patients ≥80 years of age

Boulouis¹,

Dumont²,

Cordonnier³

et al. 2011

J Neurol

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Despite increasing life expectancy, few data exist on the outcome of elderly stroke patients treated with IV thrombolysis. We analyzed the prospectively collected data from the Lille University Hospital stroke unit on patients treated with IV rt-PA within 4.5 h, comparing patients ≥80 years to younger ones. We considered the following outcomes: neurological improvement at the acute phase (NIHSS 0 or 1 at 24 h, or if the difference between NIHSS at 24 h and at baseline was ≥4), occurrence of intracerebral haemorrhage, mortality and functional outcome in survivors (favourable if mRS ≤2 or equal to pre-stroke score) at 3 months. Predictors of vital and functional outcome were determined using logistic regression analysis. Four hundred patients were treated with IV rt-PA, 98 (25%) being ≥80 years. The proportion of patients with neurological improvement at the acute phase (31 vs. 40%, OR 0.7, 95%CI 0.4-1.2), and with ICH (19 vs. 21%, OR 0.9, 95%CI 0.5-1.7) was similar among older and younger patients. At 3 months, 35% of patients ≥80 years had died; 52% of survivors had favourable functional outcome. Using multivariate analysis, age ≥80 years was an independent predictor of death (3.4; 95%CI 1.6-7.3), and of reduced likelihood of favourable functional outcome in survivors (OR 0.3; 95%CI 0.2-0.7) at 3 months. Although outcome at 3 months is worse for older patients than for their younger counterparts, our results are encouraging with a similar proportion of patients with early neurological improvement and with ICH in old and young patients and about half of the survivors having a favourable functional outcome in patients ≥80 years.

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Intravenous Thrombolysis for Acute Cerebral Ischaemia: Comparison of Outcomes between Patients Treated at Working versus Nonworking Hours

Cited by 33 publications

References 51 publications

Within-Day and Weekly Variations of Thrombolysis in Acute Ischemic Stroke

Within-Day and Weekly Variations of Thrombolysis in Acute Ischemic Stroke

Impact of Hospital Admission During Nonworking Hours on Patient Outcomes After Thrombolysis for Stroke

Intravenous thrombolysis for acute cerebral ischaemia in old stroke patients ≥80 years of age

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