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Early treatment after stroke reduced in-hospital mortality
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In a large study of data from nearly 60,000 patients with acute ischemic stroke, researchers found that earlier thrombolytic treatment was associated with reduced in-hospital mortality and symptomatic intracranial hemorrhage, and higher rates of independent ambulation at discharge and discharge to home.
Jeffrey L. Saver, MD, of the David Geffen School of Medicine at University of California, Los Angeles, and colleagues examined data from 58,353 patients (median age, 72 years) with acute ischemic stroke treated with IV tissue-type plasminogen activator (tPA) within 4.5 hours of symptom onset. Patients were from 1,395 hospitals participating in the Get With The Guidelines Stroke Program between April 2003 and March 2012.
Overall, median onset to treatment time was 144 minutes. Greater stroke severity, arrival by ambulance and arrival during regular hours were patient factors most strongly associated with shorter onset to treatment times.
Jeffrey L. Saver
Among all patients, researchers reported 8.8% had in-hospital death, 4.9% intracranial hemorrhage, 33.4% independent ambulation at hospital discharge and 38.6% of all patients were discharged to home.
For every 15-minute-faster interval of tPA treatment, mortality and symptomatic intracranial hemorrhage were less likely to occur (OR=0.96; 95% CI, 0.95-0.98 for both) and independent ambulation at hospital discharge (OR=1.04; 95% CI, 1.03-1.05) and discharge to home (OR=1.03; 95% CI, 1.02-1.04) were more likely to occur. Among patients treated within 90 minutes after symptom onset, patients were 26% less likely to die, 28% less likely to develop symptomatic intracranial hemorrhage, 51% more likely to have independent ambulation at hospital discharge and 33% more likely to discharge to home vs. patients treated 180 to 270 minutes after symptom onset.
“These findings support intensive efforts to accelerate patient presentation and to streamline regional and hospital systems of acute stroke care to compress onset to treatment times,” Saver and colleagues wrote.
Disclosure: See the full study for the researchers’ relevant financial disclosures.
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