Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke

Saver, Jeffrey L.; Fonarow, Gregg C.; Smith, Eric E.; Reeves, Mathew J.; Grau‐Sepulveda, Maria V.; Pan, Wenqin; Olson, DaiWai M.; Hernandez, Adrian F.; Peterson, Eric D.; Schwamm, Lee H.

doi:10.1001/jama.2013.6959

Cited by 695 publications

(564 citation statements)

References 31 publications

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“…[4][5][6] The benefit is markedly time-dependent and wanes within hours of stroke ictus, reflecting a progression of irreparable core infarction and increasing the risk of hemorrhagic transformation. [7][8][9][10] The American Heart Association/American Stroke Association (AHA/ASA) guidelines for early management of AIS reflect the central importance of early thrombolysis; tPA administration is recommended within 4.5 hours of symptom onset and within 1 hour of arrival at a hospital. 11 Although early thrombolysis is clearly beneficial, practical challenges persist such that the majority of stroke victims who are eligible for tPA do not receive it within the recommended times.…”

Section: Introductionmentioning

confidence: 99%

Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital

Threlkeld

Kozak

McCoy

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Background and Purpose: Shorter time-to-thrombolysis in acute ischemic stroke (AIS)is associated with improved functional outcome and reduced morbidity. We evaluate the effect of several interventions to reduce time-to-thrombolysis at an urban, public safety net hospital. Methods: All patients treated with tissue plasminogen activator for AIS at our institution between 2008 and 2015 were included in a retrospective analysis of door-to-needle (DTN) time and associated factors. Between 2011 and 2014, we implemented 11 distinct interventions to reduce DTN time.Here, we assess the relative impact of each intervention on DTN time. Results:The median DTN time pre-and postintervention decreased from 87 (interquartile range: 68-109) minutes to 49 (interquartile range: 39-63) minutes. The reduction was comprised primarily of a decrease in median time from computed tomography scan order to interpretation. The goal DTN time of 60 minutes or less was achieved in 9% (95% confidence interval: 5%-22%) of cases preintervention, compared with 70% (58%-81%) postintervention. Interventions with the greatest impact on DTN time included the implementation of a stroke group paging system, dedicated emergency department stroke pharmacists, and the development of a stroke code supply box. Conclusions: Multidisciplinary, collaborative interventions are associated with a significant and substantial reduction in time-to-thrombolysis. Such targeted interventions are efficient and achievable in resource-limited settings, where they are most needed.

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Section: Introductionmentioning

confidence: 99%

Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital

Threlkeld

Kozak

McCoy

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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“…8 This same study demonstrated improved outcomes and less hemorrhage with every 15 minute improvement in OTT. 8 There are data to suggest that pre-arrival notification by EMS improves stroke Keywords: acute care coordination; mobile technology; stroke; therapy Abbreviations: AIS: acute ischemic stroke CMS: Center for Medicare and Medicaid Services DTN: door-to-needle ED: emergency department EMS: Emergency Medical Services OTT: onset-to-treatment TPA: Tissue Plasminogen Activator therapy times; however, this notification appears inconsistent and did not occur in one-quarter of EMS cases reported in a large study of over 371,000 patients. 9,10 Given these associations of improved outcomes with the improved OTT times observed, EMS plays a large role in the care of these patients.…”

Section: Introduction and Objectivesmentioning

confidence: 74%

Stop Stroke: A Brief Report on Door-to-Needle Times and Performance After Implementing an Acute Care Coordination Medical Application and Implications to Emergency Medical Services

Dickson

Nedelcut

2017

Prehosp. Disaster med.

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ObjectiveThe objective of this study was to evaluate the effect of the Stop Stroke (Pulsara; Bozeman, Montana USA) medical application on door-to-needle (DTN) time in patients presenting to the emergency department (ED) with an acute ischemic stroke (AIS).MethodsThis was a retrospective cohort study of the Good Shepherd Health System (Longview, Texas USA) stroke quality improvement dashboard for a 25-month period from February 2012 through February 2014. Data analysis includes all data from Center for Medicare and Medicaid Services (CMS; Baltimore, Maryland USA) reportable cases receiving Tissue Plasminogen Activator (TPA) for AIS during the study period. The primary outcome was mean DTN times before and after initiating Stop Stroke. Secondary outcome was the effect on the DTN≤60-minute benchmark.ResultsDuring the study period, there were 533 stroke activations (200 before Stop Stroke implementation and 333 after). A total of 68 patients meeting inclusion criteria were analyzed (34 pre-app and 34 post- app). The observed mean DTN times post-app decreased 21 minutes (77 to 56 minutes), a 28% improvement (P=.001). Further, the patients meeting DTN≤60 minutes improved from 32% (11 of 34) to 82% (28 of 34) after the app’s implementation.ConclusionsIn this cohort of patients with AIS, Stop Stroke improved mean DTN times and number of patients treated within 60 minutes of arrival. These results demonstrate the app’s effect of increasing awareness of suspected AIS and improving coordination of care, evidenced by the magnitude of its effect on treatment times.DicksonR, NedelcutA, McPeek NedelcutM. Stop Stroke: a brief report on door-to-needle times and performance after implementing an acute care coordination medical application and implications to Emergency Medical Services. Prehosp Disaster Med. 2017;32(3):343–347.

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“…Expedient administration of intravenous recombinant tissue plasminogen activator (IV rtPA) within 4.5 hours was the first treatment approved for acute ischemic stroke (1)(2)(3). However, this treatment has drawbacks, which not only include a low recanalization rate but also a small range of application because of the limited time window and extensive exclusion criteria (4,5).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Solitaire-FR and Trevo-ProVue Thrombectomy in Patients with Anterior Circulation Large Artery Occlusion

2017

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Background: Recent randomized controlled trials have recommended stentriever thrombectomy as an important modality in treating acute ischemic stroke. Objectives: This study compares Solitaire-FR (ST) and Trevo-ProVue (TV) in terms of their angiographic recanalization rates and clinical outcomes in acute ischemic stroke patients with anterior circulation large artery occlusion. Patients and Methods: Forty-seven patients who underwent stentriever thrombectomy using ST or TV were retrospectively reviewed. Successful angiographic recanalization was defined as a modified treatment in cerebral ischemia (mTICI) score of 2b-3 and a good outcome was defined as a modified Rankin scale score (mRS) of 0 -2 at 3 months. We compared angiographic and clinical outcomes of ST-and TV-treated patients.

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Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke

Cited by 695 publications

References 31 publications

Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital

Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital

Stop Stroke: A Brief Report on Door-to-Needle Times and Performance After Implementing an Acute Care Coordination Medical Application and Implications to Emergency Medical Services

Comparison of Solitaire-FR and Trevo-ProVue Thrombectomy in Patients with Anterior Circulation Large Artery Occlusion

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