Stroke Thrombolysis: Beating the Clock

Abstract

A bstract Background Recombinant tissue plasminogen activator (rtPA) has revolutionized the management of acute ischemic stroke. Shorter door-to-imaging and door-to-needle (DTN) times are crucial for improving the outcomes in thrombolysed patients. Our observational study evaluated the door-to-imaging time (DIT) and DTN times for all thrombolysed patients. Materials and methods The study was a cross-sectional observational study over a period of 18 months at a tertiary care teaching hospital and included 252 acute ischemic stroke patients of which 52 underwent thrombolysis with rtPA. The time intervals between arrival to neuroimaging and initiation of thrombolysis were noted. Result Of the total patients thrombolysed, only 10 patients underwent neuroimaging [non-contrast computed tomography (NCCT) head with MRI brain screen] within 30 minutes of their arrival in the hospital, 38 patients within 30–60 minutes and 2 each within the 61–90 and 91–120 minute time frames. The DTN time was 30–60 minutes for 3 patients, while 31 patients were thrombolysed within 61–90 minutes, 7 patients within 91–120 minutes, while 5 each took 121–150 and 151–180 minutes for the same. One patient had a DTN between 181 and 210 minutes. Conclusion Most patients included in the study underwent neuroimaging within 60 minutes and subsequent thrombolysis within 60–90 minutes of their arrival in the hospital. But the time frames did not meet the recommended ideal intervals, and further streamlining of stroke management is needed even at tertiary care centers in India. How to cite this article Shah A, Diwan A. Stroke Thrombolysis: Beating the Clock. Indian J Crit Care Med 2023;27(2):107–110.

Correlation of Quality Metrics of Acute Stroke Care with Clinical Outcomes in an Indian Tertiary-care University Hospital: A Prospective Evidence-based Study

“… 21 In a recently published Indian study, the majority (73%) of patients had a DIT of 30–60 minutes, whereas only 19% of the patients had less than 30 minutes. 22 In our analysis, nearly 45–50% of the patients admitted with ischemic stroke (IS) had DIT below 30 minutes. This means, that a 50% scope of improvement exists at our center.…”

Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective

“…The time of onset of symptoms, time of arrival to the hospital, and time of thrombolysis were noted. 9 NIHSS scores below 3 and more than 25 were considered contraindications to thrombolysis. The reasons for delay in presentation and further in-hospital delays preventing thrombolysis were recorded.…”

“…This study included 252 acute ischemic stroke patients who presented to our institute, out of which 50 patients were thrombolyzed with Alteplase. 9 In total, 200 patients, accounting for over 79% of the stroke patients, were not given TLT owing to various reasons as 121 (60.5 %) of these were males, while 79 (39.5%) were females. The mean age of patients included in the study was 60.36 years (range 18–95) with a standard deviation of ± 15.41, as shown in Table 1 .…”

Readiness of the Stroke Treatment in India – Still an Uphill Task!

“…10 Even after reaching the hospital, in-hospital delays should be minimized, by implementing well-organized workflows (stroke codes) to achieve the desired door to needle times. 11 …”