From clock to outcomes: Time to thrombolytics and functional outcomes in acute ischemic stroke

Thrombolytics are indicated in acute ischemic stroke in eligible patients if administered within 4.5 h of symptom onset. Literature has demonstrated that shorter door-to-needle times improve all-cause mortality and readmission rates, however, it does not report the impact on quality of life. The purpose of this study is to evaluate functional outcomes when alteplase is administered early (< 45 min) versus delayed (≥ 45 min) from time of hospital arrival as well as barriers to meeting goal door-to-needle time.

This retrospective, cohort study captured 179 adult patients who received alteplase following diagnosis of acute ischemic stroke between December 2018 and October 2022. The primary endpoint was poor functional status upon hospital discharge, defined as a modified Rankin Score ≥ 2. Secondary endpoints included reasons for alteplase delay and incidence of intracranial hemorrhage.

The median age was 66 [58.5-77.0] years and 49.7 % of the study population was male. For the primary outcome of modified Rankin Score ≥ 2 at discharge, there was no difference between the early and delayed administration groups (67.5 % vs 70.7 %). The incidence of any intracranial hemorrhage was more common in the early administration group (20.0 % vs 11.1 %) In addition, patient consent and neuroimaging results were common barriers clinicians may face when determining eligibility for thrombolytic therapy.

Our study highlights that optimal administration times of thrombolytics remain an area of uncertainty and provides a framework for future studies to further assess long-term functional outcomes and patient-specific barriers to thrombolytic administration.