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Effects of Extending the Time Window of Thrombolysis to 4.5 Hours: Observations in the Swedish Stroke Register (Riks-Stroke).

Asplund, Kjell; Glader, Eva-Lotta; Norrving, Bo LU and Eriksson, Marie (2011) In Stroke: a journal of cerebral circulation 42(9). p.2492-2497
Abstract
BACKGROUND AND PURPOSE:

The European Cooperative Acute Stroke Study (ECASS) III trial and Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) data were published in 2008. Riks-Stroke, the Swedish Stroke Register, was used to explore how thrombolysis in the 3- to 4.5-hour window has been spread in different hospitals and patient groups and what effects this has had on treatment within 3 hours.



METHODS:

All 76 hospitals in Sweden admitting patients with acute stroke participate in Riks-Stroke. During the study period, January 2003 to June 2010, 92 150 18- to 80-year-old patients were hospitalized for acute ischemic stroke.



... (More)
BACKGROUND AND PURPOSE:

The European Cooperative Acute Stroke Study (ECASS) III trial and Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) data were published in 2008. Riks-Stroke, the Swedish Stroke Register, was used to explore how thrombolysis in the 3- to 4.5-hour window has been spread in different hospitals and patient groups and what effects this has had on treatment within 3 hours.



METHODS:

All 76 hospitals in Sweden admitting patients with acute stroke participate in Riks-Stroke. During the study period, January 2003 to June 2010, 92 150 18- to 80-year-old patients were hospitalized for acute ischemic stroke.



RESULTS:

After the publication of the ECASS III results in the third quarter of 2008, thrombolysis in the 3- to 4.5-hour window increased from 0.5% before publication to 2.1% in 2010. Thrombolysis in the 3- to 4.5-hour window spread somewhat faster in men than women (P=0.04) but at a similar rate in different age groups. The use of thrombolysis within 3 hours after onset of symptoms increased successively from 0.9% in 2003 to 6.6% in late 2008 and then it stabilized at 6%. The median time from arrival to the hospital to start of treatment remained unchanged at 66 to 69 minutes before and after 2008 (P=0.06).



CONCLUSIONS:

Since the end of 2008, there has been a rapid nationwide dissemination of thrombolysis in the 3- to 4.5-hour window, whereas rates in the <3-hour window have leveled off. The extended time window has not affected door-to-needle time. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
thrombolysis, rtPA, implementation, acute ischemic stroke, delay of treatment
in
Stroke: a journal of cerebral circulation
volume
42
issue
9
pages
2492 - 2497
publisher
American Heart Association
external identifiers
  • wos:000294342800032
  • pmid:21799155
  • scopus:80052414466
ISSN
1524-4628
DOI
10.1161/STROKEAHA.111.618587
language
English
LU publication?
yes
id
1cecea07-ac56-4dfa-925d-6617b9874646 (old id 2151704)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21799155?dopt=Abstract
date added to LUP
2011-09-04 21:06:29
date last changed
2017-06-11 04:20:59
@article{1cecea07-ac56-4dfa-925d-6617b9874646,
  abstract     = {BACKGROUND AND PURPOSE:<br/><br>
The European Cooperative Acute Stroke Study (ECASS) III trial and Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) data were published in 2008. Riks-Stroke, the Swedish Stroke Register, was used to explore how thrombolysis in the 3- to 4.5-hour window has been spread in different hospitals and patient groups and what effects this has had on treatment within 3 hours.<br/><br>
<br/><br>
METHODS:<br/><br>
All 76 hospitals in Sweden admitting patients with acute stroke participate in Riks-Stroke. During the study period, January 2003 to June 2010, 92 150 18- to 80-year-old patients were hospitalized for acute ischemic stroke.<br/><br>
<br/><br>
RESULTS:<br/><br>
After the publication of the ECASS III results in the third quarter of 2008, thrombolysis in the 3- to 4.5-hour window increased from 0.5% before publication to 2.1% in 2010. Thrombolysis in the 3- to 4.5-hour window spread somewhat faster in men than women (P=0.04) but at a similar rate in different age groups. The use of thrombolysis within 3 hours after onset of symptoms increased successively from 0.9% in 2003 to 6.6% in late 2008 and then it stabilized at 6%. The median time from arrival to the hospital to start of treatment remained unchanged at 66 to 69 minutes before and after 2008 (P=0.06).<br/><br>
<br/><br>
CONCLUSIONS:<br/><br>
Since the end of 2008, there has been a rapid nationwide dissemination of thrombolysis in the 3- to 4.5-hour window, whereas rates in the &lt;3-hour window have leveled off. The extended time window has not affected door-to-needle time.},
  author       = {Asplund, Kjell and Glader, Eva-Lotta and Norrving, Bo and Eriksson, Marie},
  issn         = {1524-4628},
  keyword      = {thrombolysis,rtPA,implementation,acute ischemic stroke,delay of treatment},
  language     = {eng},
  number       = {9},
  pages        = {2492--2497},
  publisher    = {American Heart Association},
  series       = { Stroke: a journal of cerebral circulation},
  title        = {Effects of Extending the Time Window of Thrombolysis to 4.5 Hours: Observations in the Swedish Stroke Register (Riks-Stroke).},
  url          = {http://dx.doi.org/10.1161/STROKEAHA.111.618587},
  volume       = {42},
  year         = {2011},
}