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Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019
R. Mikulík, M. Bar, S. Bělašková, D. Černík, J. Fiksa, R. Herzig, R. Jura, L. Jurák, L. Klečka, J. Neumann, S. Ostrý, D. Šaňák, P. Ševčík, O. Škoda, M. Šrámek, A. Tomek, D. Václavík, Czech Stroke Unit Network
Jazyk angličtina Země Velká Británie
Typ dokumentu časopisecké články
NLK
Directory of Open Access Journals
od 2012
Free Medical Journals
od 2012
PubMed Central
od 2012
Europe PubMed Central
od 2012
Open Access Digital Library
od 2012-01-01
Open Access Digital Library
od 2012-01-01
Open Access Digital Library
od 2015-01-01
Wiley-Blackwell Open Access Titles
od 2012
ROAD: Directory of Open Access Scholarly Resources
od 2012
PubMed
35574953
DOI
10.1161/jaha.121.023524
Knihovny.cz E-zdroje
- MeSH
- cerebrální krvácení komplikace MeSH
- cévní mozková příhoda * terapie MeSH
- fibrinolytika škodlivé účinky MeSH
- intravenózní podání MeSH
- ischemie mozku * komplikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tkáňový aktivátor plazminogenu MeSH
- trombolytická terapie škodlivé účinky metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
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.
Comprehensive Stroke Center Hospital České Budějovice a s České Budějovice Czech Republic
Department of Neurology Chomutov Hospital KZ a s Chomutov Czech Republic
Department of Neurology Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic
Department of Neurology Hospital Jihlava Jihlava Czech Republic
Department of Neurology Town Hospital Ostrava Ostrava Czech Republic
Department of Neurology University Hospital Brno Brno Czech Republic
Department of Neurology University Hospital Pilsen Pilsen Czech Republic
Faculty of Medicine at Masaryk University Brno Czech Republic
Military University Hospital Prague Czech Republic
Neurocenter Regional Hospital Liberec Liberec Czech Republic
Citace poskytuje Crossref.org
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