Association of time from last known well to alteplase administration and outcomes in acute stroke.

INTRODUCTION

In order to determine if time from onset to treatment time (OTT) to alteplase (tPA) administration is associated with improved outcomes in acute ischemic stroke, we performed a retrospective analysis of all acute ischemic stroke patients who received tPA at our hospital.

METHODS

We performed a retrospective review of our Get With the Guidelines® stroke data to determine OTT was associated with either 1.) modified Rankin scale (mRS) at 90 days or 2.) in hospital hemorrhagic conversion. OTT was examined both as a continuous variable in univariate and multivariate analyses as well as a dichotomous variable with a cutoff of 60 min. We controlled for demographic characteristics, 24 medical history issues, receipt of thrombectomy, and NIH stroke scale at admission.

RESULTS

We included 166 patients with data for mRS at 90 days after discharge and 302 patients for hemorrhagic conversion in hospital. In all analyses, there was no difference between OTT in either outcome. Predictors of improved mRS at 90 days included NIH Stroke Scale at admission, age, and lack of hypertension. The only significant predictors for hemorrhagic conversion was NIH stroke scale at admission.

CONCLUSION

Our small, retrospective data shows no association between OTT and either hemorrhagic conversion or mRS at 90 days. This data lends support that time may not be the ideal indicator for identifying patients who will benefit from tPA administration.