Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Longer tPA Administration Time in Early Presenters
J Stroke Cerebrovasc Dis; ePub 2016 Aug 23; Rossi, et al
In ischemic stroke, administration of tissue plasminogen activator (tPA) within 4.5 hours from the time last known well (LKW) improves outcomes, with better outcomes seen with earlier administration. In a recent study, there was a significant negative correlation between the LKW-to-code time and the code-to-tPA time that was independent of age, sex, National Institutes of Health Stroke Scale (NIHSS) score, and race/ethnicity. In the Mount Sinai Hospital Stroke Registry (2009 to 2015), 122 patients received tPA. Researchers divided patients by LKW-to-code time in 3 groups: 0 to 59 minutes (n=38), 60 to 119 minutes (n=49), and 120 minutes or more (n=35). They found:
- The average code-to-tPA time was 80 minutes in the 0 to 59 minutes group, 67 minutes in the 60 to 119 minutes group, and 52 minutes in the 120 minutes or more group.
- There was an average 28-minute difference between 0 to 59 and 120 or more groups.
Rossi KC, Liang JW, Wilson, N, Tuhrim S, Dhamoon MS. More time is taken to administer tissue plasminogen activator in ischemic stroke patients with earlier presentations. [Published online ahead of print August 23, 2016]. J Stroke Cerebrovasc. doi:10.1016/j.jstrokecerebrovasdis.2016.08.031.