Thrombolytic Administration for Acute Ischemic Stroke
Background: The therapeutic benefit of tissue plasminogen activator (tPA) for acute ischemic stroke is provenbut extremely time-dependent. Current guidelines recommend a <60 minute door-to-needle time. We identify here factors affecting door-to-needle time of tPA administration for acute ischemi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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McGill University
2022-03-01
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| Series: | McGill Journal of Medicine |
| Subjects: | |
| Online Access: | https://mjm.mcgill.ca/article/view/881 |
| _version_ | 1818720913527406592 |
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| author | Abraham Akbar Nicholas Peoples Hangyu Xie Paulina Sergot Haitham Hussein William Frank Peacock IV Zubaid Rafique |
| author_facet | Abraham Akbar Nicholas Peoples Hangyu Xie Paulina Sergot Haitham Hussein William Frank Peacock IV Zubaid Rafique |
| author_sort | Abraham Akbar |
| collection | DOAJ |
| description |
Background: The therapeutic benefit of tissue plasminogen activator (tPA) for acute ischemic stroke is provenbut extremely time-dependent. Current guidelines recommend a <60 minute door-to-needle time. We identify here factors affecting door-to-needle time of tPA administration for acute ischemic stroke.
Methods: We conducted a retrospective chart review of an emergency department from 2010 to 2013. Inclusion criteria were discharge diagnosis of acute ischemic stroke and tPA administration within 4.5 hours of onset. Exclusion criteria were non-ischemic strokes (transient ischemic attacks, subarachnoid hemorrhage, intracerebral hemorrhage) or those given tPA >4.5 hours. We used a linear regression model to quantify factor influence and compared tPA administration benchmark times to target benchmark times (median + quartiles).
Results: Among the 71 ischemic stroke patients included, 38 (54%) received tPA within ≤ 60 minutes. Female sex was associated with a door-to-needle time delay of 13.97 minutes (95% CI 3.412 to 27.111). Median benchmark times did not show evidence of delay in any benchmark in comparison with target benchmark times.
Conclusion: Female sex was associated with increased door-to-needle time. Further investigation of these areas may enable optimized workflow, decreased door-to-needle times, and improved patient outcomes.
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| first_indexed | 2024-12-17T20:30:23Z |
| format | Article |
| id | doaj.art-54e42e40752d4551977419ca9b6e9e6f |
| institution | Directory Open Access Journal |
| issn | 1715-8125 |
| language | English |
| last_indexed | 2024-12-17T20:30:23Z |
| publishDate | 2022-03-01 |
| publisher | McGill University |
| record_format | Article |
| series | McGill Journal of Medicine |
| spelling | doaj.art-54e42e40752d4551977419ca9b6e9e6f2022-12-21T21:33:36ZengMcGill UniversityMcGill Journal of Medicine1715-81252022-03-0120110.26443/mjm.v20i1.881Thrombolytic Administration for Acute Ischemic StrokeAbraham Akbar0Nicholas Peoples1Hangyu Xie2Paulina Sergot3Haitham Hussein4William Frank Peacock IV5Zubaid Rafique6Baylor College of Medicine, Houston, TX, USABaylor College of Medicine, Houston, TX, USADepartment of Statistics, Rice University, Houston, TX, USADepartment of Emergency Medicine, McGovern Medical School, Houston, TX, USARegions Hospital Comprehensive Stroke Center, Saint Paul, MN, USADepartment of Emergency Medicine, Baylor College of Medicine, Houston, TX, USADepartment of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA Background: The therapeutic benefit of tissue plasminogen activator (tPA) for acute ischemic stroke is provenbut extremely time-dependent. Current guidelines recommend a <60 minute door-to-needle time. We identify here factors affecting door-to-needle time of tPA administration for acute ischemic stroke. Methods: We conducted a retrospective chart review of an emergency department from 2010 to 2013. Inclusion criteria were discharge diagnosis of acute ischemic stroke and tPA administration within 4.5 hours of onset. Exclusion criteria were non-ischemic strokes (transient ischemic attacks, subarachnoid hemorrhage, intracerebral hemorrhage) or those given tPA >4.5 hours. We used a linear regression model to quantify factor influence and compared tPA administration benchmark times to target benchmark times (median + quartiles). Results: Among the 71 ischemic stroke patients included, 38 (54%) received tPA within ≤ 60 minutes. Female sex was associated with a door-to-needle time delay of 13.97 minutes (95% CI 3.412 to 27.111). Median benchmark times did not show evidence of delay in any benchmark in comparison with target benchmark times. Conclusion: Female sex was associated with increased door-to-needle time. Further investigation of these areas may enable optimized workflow, decreased door-to-needle times, and improved patient outcomes. https://mjm.mcgill.ca/article/view/881StrokeThrombolysisEmergency DepartmentWorkflow |
| spellingShingle | Abraham Akbar Nicholas Peoples Hangyu Xie Paulina Sergot Haitham Hussein William Frank Peacock IV Zubaid Rafique Thrombolytic Administration for Acute Ischemic Stroke McGill Journal of Medicine Stroke Thrombolysis Emergency Department Workflow |
| title | Thrombolytic Administration for Acute Ischemic Stroke |
| title_full | Thrombolytic Administration for Acute Ischemic Stroke |
| title_fullStr | Thrombolytic Administration for Acute Ischemic Stroke |
| title_full_unstemmed | Thrombolytic Administration for Acute Ischemic Stroke |
| title_short | Thrombolytic Administration for Acute Ischemic Stroke |
| title_sort | thrombolytic administration for acute ischemic stroke |
| topic | Stroke Thrombolysis Emergency Department Workflow |
| url | https://mjm.mcgill.ca/article/view/881 |
| work_keys_str_mv | AT abrahamakbar thrombolyticadministrationforacuteischemicstroke AT nicholaspeoples thrombolyticadministrationforacuteischemicstroke AT hangyuxie thrombolyticadministrationforacuteischemicstroke AT paulinasergot thrombolyticadministrationforacuteischemicstroke AT haithamhussein thrombolyticadministrationforacuteischemicstroke AT williamfrankpeacockiv thrombolyticadministrationforacuteischemicstroke AT zubaidrafique thrombolyticadministrationforacuteischemicstroke |