title: Effects of extending the time window of thrombolysis to 4.5 hours: observations in the Swedish stroke register (riks-stroke).
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Statistics, Umeå University, SE-901 87 Umeå, Sweden.
authors.forename: Kjell
authors.initials: K
authors.lastname: Asplund
authors.forename: Eva-Lotta
authors.initials: EL
authors.lastname: Glader
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.forename: Marie
authors.initials: M
authors.lastname: Eriksson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D020521:Stroke / Q000628:therapy*; D013548:Sweden; D015912:Thrombolytic Therapy; D013997:Time Factors