Rapid Thrombolysis Protocol: Results from a Before-and-after Study

Area of Science:

• Emergency Medicine
• Neurology
• Clinical Protocols

Background:

• Intravenous thrombolysis is a critical treatment for acute ischemic stroke, with established benefits within 4.5 hours of onset.
• The standard goal for door-to-needle (DTN) time in emergency departments is within 60 minutes of patient arrival.
• Current processes may delay thrombolysis, impacting patient outcomes.

Purpose of the Study:

• To evaluate the effectiveness of a novel rapid thrombolysis protocol (RTPr) in reducing DTN times.
• To assess the impact of the RTPr on patient recovery and functional outcomes after stroke.
• To determine if the RTPr can be implemented to improve stroke care efficiency.

Main Methods:

• A before-and-after study design was employed at a single center.
• Patients receiving intravenous thrombolysis were divided into pre-intervention (standard care) and post-intervention (RTPr) groups.
• Primary outcomes included DTN time, time to recovery, and modified Rankin Scale (mRS) score at discharge; secondary outcomes included mortality and complications.

Main Results:

• The mean DTN time was significantly reduced from 56.15 minutes in the pre-intervention group to 34.91 minutes in the post-intervention group (p < 0.001).
• Neurological recovery within 24 hours was observed in 43.24% of the pre-intervention group and 41.89% of the post-intervention group.
• A favorable discharge mRS score (0-2) was achieved by 36.49% of patients in the pre-intervention group and 54.05% in the post-intervention group.

Conclusions:

• The rapid thrombolysis protocol (RTPr) effectively decreases door-to-needle times in stroke patients.
• Implementation of the RTPr is associated with improved functional outcomes at discharge.
• Clinicians and hospitals can adapt this protocol to optimize emergency stroke treatment and patient care.