title: Stroke thrombolysis: having more time translates into delayed therapy: data from the Austrian Stroke Unit Registry.
abstract: OBJECTIVE
  Efficacy of intravenous thrombolysis in acute ischemic stroke declines with increasing time to treatment initiation. Previous small-scale studies suggested that the earlier patients arrive, the longer it takes to administer recombinant tissue plasminogen activator.
  
  
  METHODS
  Of 32 529 patients with stroke prospectively enrolled in the Austrian Stroke Unit Registry (2004 to 2009), 3287 received intravenous thrombolysis and 2663 of them were eligible for the current analysis.
  
  
  RESULTS
  Median (interquartile range) onset-to-door and door-to-needle times were 70 (50 to 100) and 50 (35 to 70) minutes. Of note, both time intervals were inversely correlated with each other. After adjustment for multiple stroke characteristics, the door-to-needle time of patients arriving in the hospital within the first hour after stroke onset was 6.9 minutes (P<0.001) and 13.9 minutes (P<0.001) longer than those for patients arriving between 61 to 120 and 121 to 180 minutes. Findings were consistent in subgroups.
  
  
  CONCLUSIONS
  Early hospital arrival translates into a significant delay in the application of intravenous thrombolysis among patients with acute stroke. This finding calls for concerted measures to ensure that all patients with stroke are treated with the same urgency irrespective of the time available.
authors.affiliation: Department of Neurology, Hospital Barmherzige Brueder, Vienna, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Ferrari
authors.forename: Michael
authors.initials: M
authors.lastname: Knoflach
authors.forename: Stefan
authors.initials: S
authors.lastname: Kiechl
authors.forename: Johann
authors.initials: J
authors.lastname: Willeit
authors.forename: Benjamin
authors.initials: B
authors.lastname: Matosevic
authors.forename: Leonhard
authors.initials: L
authors.lastname: Seyfang
authors.forename: Wilfried
authors.initials: W
authors.lastname: Lang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012042:Registries; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator