Detailed Information on Publication Record
2022
Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019
MIKULÍK, Robert, Michal BAR, Silvie BELASKOVA, David CERNIK, Jan FIKSA et. al.Basic information
Original name
Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019
Authors
MIKULÍK, Robert (203 Czech Republic, belonging to the institution), Michal BAR (203 Czech Republic), Silvie BELASKOVA (203 Czech Republic), David CERNIK (203 Czech Republic), Jan FIKSA (203 Czech Republic), Roman HERZIG (203 Czech Republic), René JURA (203 Czech Republic, belonging to the institution), Lubomir JURAK (203 Czech Republic), Lukas KLECKA (203 Czech Republic), Jiri NEUMANN (203 Czech Republic), Svatopluk OSTRY (203 Czech Republic), Daniel SANAK (203 Czech Republic), Petr SEVCIK (203 Czech Republic), Ondrej SKODA (203 Czech Republic), Martin SRAMEK (203 Czech Republic), Ales TOMEK (203 Czech Republic) and Daniel VACLAVIK (203 Czech Republic)
Edition
Journal of the American Heart Association, Hoboken, Wiley-Blackwell, 2022, 2047-9980
Other information
Language
English
Type of outcome
Článek v odborném periodiku
Field of Study
30210 Clinical neurology
Country of publisher
United States of America
Confidentiality degree
není předmětem státního či obchodního tajemství
References:
Impact factor
Impact factor: 5.400
RIV identification code
RIV/00216224:14110/22:00126028
Organization unit
Faculty of Medicine
UT WoS
000796637400009
Keywords in English
acute ischemic stroke; door-to-needle time; intravenous thrombolysis; stroke logistics
Tags
International impact, Reviewed
Změněno: 16/6/2022 10:39, Mgr. Tereza Miškechová
Abstract
V originále
Background The benefit of intravenous thrombolysis is time dependent. It remains unclear, however, whether dramatic shortening of door-to-needle time (DNT) among different types of hospitals nationwide does not compromise safety and still improves outcome. Methods and Results Multifaceted intervention to shorten DNT was introduced at a national level, and prospectively collected data from a registry between 2004 and 2019 were analyzed. Generalized estimating equation was used to identify the association between DNT and outcomes independently from prespecified baseline variables. The primary outcome was modified Rankin score 0 to 1 at 3 months, and secondary outcomes were parenchymal hemorrhage/intracerebral hemorrhage (ICH), any ICH, and death. Of 31 316 patients treated with intravenous thrombolysis alone, 18 861 (60%) had available data: age 70 +/- 13 years, National Institutes of Health Stroke Scale at baseline (median, 8; interquartile range, 5-14), and 45% men. DNT groups 0 to 20 minutes, 21 to 40 minutes, 41 to 60 minutes, and >60 minutes had 3536 (19%), 5333 (28%), 4856 (26%), and 5136 (27%) patients. National median DNT dropped from 74 minutes in 2004 to 22 minutes in 2019. Shorter DNT had proportional benefit: it increased the odds of achieving modified Rankin score 0 to 1 and decreased the odds of parenchymal hemorrhage/ICH, any ICH, and mortality. Patients with DNT <= 20 minutes, 21 to 40 minutes, and 41 to 60 minutes as compared with DNT >60 minutes had adjusted odds ratios for modified Rankin score 0 to 1 of the following: 1.30 (95% CI, 1.12-1.51), 1.33 (95% CI, 1.15-1.54), and 1.15 (95% CI, 1.02-1.29), and for parenchymal hemorrhage/ICH: 0.57 (95% CI, 0.45-0.71), 0.76 (95% CI, 0.61-0.94), 0.83 (95% CI, 0.70-0.99), respectively. Conclusions Ultrashort initiation of thrombolysis is feasible, improves outcome, and makes treatments safer because of fewer intracerebral hemorrhages. Stroke management should be optimized to initiate thrombolysis as soon as possible optimally within 20 minutes from arrival to a hospital.
Links
| LM2018128, research and development project |
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