Week 6: Management of Acute Stroke, part 1

Now that we’re finally through the guidelines, we’ll be taking a look at some more of the evidence for acute stroke.

#14: Time to treatment with IV tPA and outcome from acute ischemic stroke

  • In acute stroke, the volume of irreversibly injured tissue expands quickly: estimated loss of 2 million neurons per minute!
  • The combined tPA trials only included 1850 patients, not really enough to show a clear effect from time to treatment
  • This study used 10 years of data from a nationwide registry, the AHA/ASA Get With The Guidelines–Stroke registry, which after exclusion for a variety of factors, still had 58k patients’ worth of data to analyse
  • The median time to treatment was 144 minutes
  • More rapid administration of tPA was associated with essentially all outcomes: reduced mortality, fewer symptomatic ICHs, and more frequent discharge home vs death or to an institution
  • When tPA was given within 90 minutes, patients were 26% less likely to die, and 50% more likely to be ambulatory at discharge vs those who got it between 3-4.5 hours


So, I mean, I think we kind of already knew this, even if not 100%…I was a little surprised when I realized the paper was published in 2013. But more evidence is always good, right? PS is it just me or is database analysis the route to getting papers published quickly? I mean, obviously it’s a lot of work, but…compared to running gels in a lab, or whatever they do? Making a mental note to learn more stats.


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