Tuesday, May 19, 2015

The earlier tpa is given, the better GWTG evidence

Saver JL, Fonarow GC, Smith EE. et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke.  JAMA 2013; 309; 2480-2488. 

Authors used real world data based on GWTG registry, covering 54,353 patients treated between 2003-2012 at 1395 institutions, and analysed in fifteen minute increments for treatment effects.  Across the ninety minute increments (0-90, 91-180, 181-270 minutes) there was no difference in hospital characteristics such as treatment time or volume, treatment rates, or designation as a stroke center.  Patients treated in first ninety minutes had higher NIHSS scores (mean 12) than those treated in the 181-270 time frame  (mean 9.0).  Nonetheless, faster treatment . 

Findings based on fifteen minute increments showed less mortality  for each 15 minute increment (0.96 OR), and increased odds of independent ambulation at discharge (or 1.03 per 15 minute increment). 

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