Earlier Treatment of Seniors After Stroke Reduces
Risk of Death, Increases Chance to Go Home
For every 15 minutes gained, death and hemorrhage was
less likely; going home in better shape more likely for these seniors
with average age of 72
July 18, 2013 With all the promotion by the
American Heart Association and others about the critical need for quick
treatment after a stroke, it is not surprising that a large new study of
senior citizens hit with acute ischemic stroke finds that thrombolytic
treatment (to help dissolve a blood clot) that was started more rapidly
after symptom onset was associated with reduced in-hospital deaths and
intracranial hemorrhage and higher rates of independent walking ability
at discharge and discharge to home.
The study, which included nearly 60,000 patients
with acute ischemic stroke, appears in the June 19 issue of the Journal
of the American Medical Association (JAMA).
The researchers found that for every
15-minute-faster interval of tPA therapy -
● mortality was less likely to occur,
● symptomatic intracranial hemorrhage was less likely to occur,
● independence in ambulation at discharge was more likely to occur,
● discharge to home was more likely to occur.
For patients treated in the first 90 minutes,
compared with 181-270 minutes after onset -
● mortality was 26 percent less likely to occur,
● symptomatic intracranial hemorrhage was 28 percent less likely to
● independence in ambulation at discharge was 51 percent more likely
to occur, and
● discharge to home was 33 percent more likely to occur.
These findings support intensive efforts to
accelerate patient presentation and to streamline regional and hospital
systems of acute stroke care to compress OTT times, the authors
Jeffrey L. Saver, M.D., of the David Geffen School
of Medicine at UCLA, Los Angeles, and colleagues conducted a study to
determine the association between time to treatment with intravenous
thrombolysis and outcomes among patients with acute ischemic stroke.
The study included data from 58,353 patients with
acute ischemic stroke treated with tPA within 4.5 hours of symptom onset
in 1,395 hospitals participating in the Get With The Guidelines-Stroke
Program, April 2003 to March 2012. The median (midpoint) age of the
patients was 72 years.
The median OTT time was 144 minutes, 9.3 percent
had OTT time of 0 to 90 minutes, 77.2 percent had OTT time of 91 to 180
minutes, and 13.6 percent had OTT time of 181 to 270 minutes.
Patient factors most strongly associated with
shorter OTT included greater stroke severity, arrival by ambulance and
arrival during regular hours. Overall, there were 5,142 (8.8 percent)
in-hospital deaths, 2,873 (4.9 percent) patients had intracranial
hemorrhage, 19,491 (33.4 percent) patients achieved independent
ambulation (walking ability) at hospital discharge, and 22,541 (38.6
percent) patients were discharged to home.
Intravenous (IV) tissue-type plasminogen activator
(tPA) is a treatment of proven benefit for select patients with acute
ischemic stroke as long as 4.5 hours after onset. Available evidence
suggests a strong influence of time to therapy on the magnitude of
treatment benefit, according to background information in the article.
Imaging studies show the volume of irreversibly
injured tissue in acute cerebral ischemia expands rapidly over time.
However, modest sample sizes have limited characterization of the
extent to which onset to treatment (OTT) time influences outcome; and
the generalizability of findings to clinical practice is uncertain.
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