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Clinical outcomes among stroke patients receiving tissue plasminogen activator therapy beyond the 3-hour time window.

Publication ,  Journal Article
O'Brien, EC; Rose, KM; Patel, MD; Murphy, CV; Rosamond, WD
Published in: J Stroke Cerebrovasc Dis
October 2012

BACKGROUND: Tissue plasminogen activator therapy (t-PA) is associated with improved neurologic outcomes and reduced disability from ischemic stroke. The current guidelines stipulate that patients receive t-PA within 3 hours of symptom onset. However, actual practice patterns vary, and little is known about patient outcomes when t-PA is received outside of the recommended time window. METHODS: We examined mean length of hospital stay, t-PA-related complications, and in-hospital death by time of t-PA administration in North Carolina Stroke Care Collaborative (NCSCC) patients. The NCSCC includes 53 hospitals that enroll patients presenting with stroke-like symptoms. Of 40,907 patients enrolled between January 2005 and February 2010, 1070 (2.6%) received t-PA. Of these, 88.2% received t-PA within 3 hours of symptom onset ("early") and 30.3% received t-PA between 3 and 6 hours after symptom onset ("late"). RESULTS: Unadjusted mean length of stay (days) was longer among early patients (5.0 days; 95% confidence interval [CI], 4.7-5.3) than late patients (3.6 days; 95% CI, 3.1-4.2). t-PA-related complications were similar among early (7.0%; 55/781) and late patients (6.7%; 7/102; P = .89). The proportion of in-hospital deaths was similar among late (10.5%) and early patients (12.0%). We used multivariable logistic regression to estimate odds ratios (ORs) and 95% CIs for the associations between late t-PA status and patient outcomes. CONCLUSIONS: In models controlling for age, race, sex, arrival mode, and ambulatory status on admission, late t-PA was not associated with increased odds of complications or in-hospital deaths (OR, 0.89; 95% CI, 0.49-1.62). The risks and benefits of expansion of the t-PA time window in stroke patients merit further investigation.

Duke Scholars

Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

October 2012

Volume

21

Issue

7

Start / End Page

541 / 546

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Time-to-Treatment
  • Time Factors
  • Thrombolytic Therapy
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Practice Guidelines as Topic
 

Citation

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O’Brien, E. C., Rose, K. M., Patel, M. D., Murphy, C. V., & Rosamond, W. D. (2012). Clinical outcomes among stroke patients receiving tissue plasminogen activator therapy beyond the 3-hour time window. J Stroke Cerebrovasc Dis, 21(7), 541–546. https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.12.004
O’Brien, Emily C., Kathryn M. Rose, Mehul D. Patel, Carol V. Murphy, and Wayne D. Rosamond. “Clinical outcomes among stroke patients receiving tissue plasminogen activator therapy beyond the 3-hour time window.J Stroke Cerebrovasc Dis 21, no. 7 (October 2012): 541–46. https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.12.004.
O’Brien EC, Rose KM, Patel MD, Murphy CV, Rosamond WD. Clinical outcomes among stroke patients receiving tissue plasminogen activator therapy beyond the 3-hour time window. J Stroke Cerebrovasc Dis. 2012 Oct;21(7):541–6.
O’Brien, Emily C., et al. “Clinical outcomes among stroke patients receiving tissue plasminogen activator therapy beyond the 3-hour time window.J Stroke Cerebrovasc Dis, vol. 21, no. 7, Oct. 2012, pp. 541–46. Pubmed, doi:10.1016/j.jstrokecerebrovasdis.2010.12.004.
O’Brien EC, Rose KM, Patel MD, Murphy CV, Rosamond WD. Clinical outcomes among stroke patients receiving tissue plasminogen activator therapy beyond the 3-hour time window. J Stroke Cerebrovasc Dis. 2012 Oct;21(7):541–546.
Journal cover image

Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

October 2012

Volume

21

Issue

7

Start / End Page

541 / 546

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Time-to-Treatment
  • Time Factors
  • Thrombolytic Therapy
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Practice Guidelines as Topic