Stroke: Speedier Thrombolysis Therapy Prolongs Disability-Free Life

Atte Meretoja, MD, PhD, MSc (Stroke Medicine) Associate Professor and Principal Fellow (Neurology), University of Melbourne The Royal Melbourne Hospital L4C, Grattan St, Parkville VIC 3050, Australia Associate Professor of Neurology, University of Helsinki Helsinki University Central Hospital, FinlandMedicalResearch.com Interview with:
Atte Meretoja, MD, PhD, MSc (Stroke Medicine)
Associate Professor and Principal Fellow (Neurology),
University of Melbourne
The Royal Melbourne Hospital Australia
Associate Professor of Neurology, University of Helsinki
Helsinki University Central Hospital, Finland

MedicalResearch.com: What are the main findings of the study?

Dr. Meretoja: We used observational prospective data of consecutive stroke patients (n=2258) treated with intravenous thrombolysis in Australian and Finnish centers and a pooled analysis of thrombolysis trials to model the shift in patient outcomes with reducing treatment delays. We found out that each minute the treatment can be delivered faster granted on average 1.8 days of extra healthy life (95% prediction interval 0.9 to 2.7). In practice, this means that each 15 minute decrease in treatment delays provides an average equivalent of one month of additional disability-free life.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Meretoja: The magnitude of benefit from small realistically achievable gains in streamlining thrombolysis services has not been quantified before. This study provides a meaningful metric and an impetus to take action.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Meretoja: Even small achievements in streamlining acute stroke services provide very large health benefits for the patient. Co-operation of the ambulance service, ED, and the stroke team is critical, and validated methods for achieving this have been described by us and others. Best practice centers currently achieve <20 minutes median in-hospital delays, while most hospitals take more than an hour, effectively losing months of healthy life with every treated patient. Every hospital should know its door-to-needle times for stroke thrombolysis, take action to reduce these, and monitor the results.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Meretoja: Intravenous thrombolysis remains the only evidence-based acute recanalization therapy in stroke. Translation to practice has been slow, with the therapy most often contraindicated due to delays. This research should promote service streamlining for the benefit of our patients. Future research should concentrate on methods to further reduce delays and increase rate of use.

Citation:

Stroke Thrombolysis Save a Minute, Save a Day

Atte Meretoja,Mahsa Keshtkaran,Jeffrey L. Saver,Turgut Tatlisumak,Mark W. Parsons,Markku Kaste,Stephen M. Davis,Geoffrey A. Donnan,and Leonid Churilov

Stroke. 2014;STROKEAHA.113.002910published online before print March 13 2014, doi:10.1161/STROKEAHA.113.002910

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