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 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.