title: Stroke Thrombolysis Protocol Shortens "Door-to-Needle Time" and Improves Outcomes-Experience at a Tertiary Care Center in Qatar.
abstract: OBJECTIVE
  To assess the effect of acute thrombolysis protocol on "door-to-needle time" (DTN) and improvement in outcome following acute stroke (AS).
  
  
  METHODS
  The charts of all patients receiving intravenous (IV) thrombolysis for AS between January 2008 and June 2015 were reviewed for DTN, complications, and clinical outcome. Good prognosis was defined as modified Rankin Scale (mRS) score of less than 2 at 90 days. In January 2014, a protocol for faster DTN was introduced. We reviewed the prognosis before and after the introduction of the new protocol.
  
  
  RESULTS
  Up to 204 patients received IV recombinant tissue plasminogen activator (r-tPA) (mean age 52.5 ± 12.4 years). Mean door-to-CT time improved from 42.5 ± 41.1 to 27.1 ± 26.3 minutes (P < .001); DTN improved from 83.26 ± 47.7 to 47.09 ± 25.7 minutes (P < .001). Complications were reduced from 15.7% to 8.8% (P = .14). The mRS score of less than or equal to 2 improved from 47.1% to 73.3% at 90 days (P = .001). After implementing new protocol, thrombolysis rate increased to 11.8% in 2014 (before 3.3% in 2011, 4.9% in 2012, and 4.4% in 2013), P < .0001. NIHSS (National Institutes of Health Stroke Scale) score at admission (P = .002), hypodensity on initial CT brain (P = .041), protocol implementation (P = .014), and reduced length of stay (P = .004) were associated with outcome at 90 days (mRS score ≤2).
  
  
  CONCLUSIONS
  Implementation of specific protocols to reduce DTN in patients receiving IV r-tPA leads to reduction in complications and improves outcome.
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Faisal
authors.initials: F
authors.lastname: Ibrahim
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Naveed
authors.initials: N
authors.lastname: Akhtar
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Abdul
authors.initials: A
authors.lastname: Salam
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Saadat
authors.initials: S
authors.lastname: Kamran
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Dirk
authors.initials: D
authors.lastname: Deleu
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Atlantic
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Imam
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Paula
authors.initials: P
authors.lastname: Bourke
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Sujatha
authors.initials: S
authors.lastname: Joseph
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Mark
authors.initials: M
authors.lastname: Santos
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Rabia
authors.initials: R
authors.lastname: Khan
authors.affiliation: Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Zain A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Anjushri
authors.initials: A
authors.lastname: Bhagat
authors.affiliation: The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar; University of Alberta, Edmonton, Alberta, Canada. Electronic address: ashuaib@hamad.qa.
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011780:Qatar / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D062606:Tertiary Care Centers; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Qatar; Thrombolysis; acute stroke; cerebral hemorrhage; cerebral infarction; thrombolysis