Each minute delay of IV thrombolysis worsens survival, functional outcomes in stroke
For every 1-minute delay in delivery of IV thrombolysis for acute ischemic stroke, the chance of survival decreased by 0.6%, researchers reported.
As door-to-needle time increased, so too did the risk for intracerebral hemorrhage and worse 90-day functional outcomes.
“Our findings highlight that door-to-needle time is a key factor in achieving favorable outcomes after a stroke, emphasizing the importance of constant improvement of in-hospital treatment routines,” David Darehed, PhD, postdoctoral researcher in the department of public health and clinical medicine at Umeå University, Sweden, and colleagues wrote. “The odds of worse outcomes per minute may seem small but translates to large numbers considering greater decreases in door-to-needle time combined with the commonness of the disease.”
The nationwide registry-based study published in Stroke assessed adult patients in Sweden admitted for stroke who underwent IV thrombolysis between 2010 and 2017 (n = 14,132; median age, 74 years; median NIH Stroke Scale score, 8 points). Researchers compared survival, intracranial hemorrhage and functional outcomes with the door-to-needle times for each patient.
Researchers observed that from 2010 to 2017, door-to-needle time decreased from approximately 65 to 38 minutes. The median door-to-needle time during the study period was 47 minutes.
Per-minute delay in door-to-needle IV thrombolysis for stroke was associated with:
- lower odds of 90-day survival (OR = 0.994; 95% CI, 0.992-0.996);
- higher odds of intracranial hemorrhage within 36 hours (OR = 1.003; 95% CI, 1-1.006);
- worse functional outcomes for daily living (OR = 1.003; 95% CI, 1.001-1.005);
- worse functional outcomes for living conditions (OR = 1.004; 95% CI, 1.002-1.005); and
- worse mobility at 3 months (OR = 1.004; 95% CI, 1.003-1.006).
“The finding that higher age, higher NIH Stroke Scale, and longer onset-to-door time was related with shorter door-to-needle time, explain why the results showed only after adjustment for confounders,” the researchers wrote. “Before 2014, patients older than 80 years were not eligible for IV thrombolysis; hence, most of these patients were included in the later part of the study, which may explain the relationship for age. Delays related to NIH Stroke Scale and onset-to-door time should be possible to target in future quality improvement efforts aiming to achieve a quick and correct stroke diagnosis.”