title: More Time Is Taken to Administer Tissue Plasminogen Activator in Ischemic Stroke Patients with Earlier Presentations.
abstract: BACKGROUND
  In ischemic stroke, administration of tissue plasminogen activator (tPA) within 4.5 hours from the time last known well (LKW) improves outcomes, with better outcomes seen with earlier administration. However, for patients presenting early, a perception of significant remaining time within this window may lead to delayed tPA administration. We hypothesized that cases with a shorter LKW-to-stroke team activation (code) time will have a longer "code-to-tPA" administration time.
  
  
  METHODS
  In the Mount Sinai Hospital Stroke Registry (2009-2015), 122 patients received tPA. The patients were divided by "LKW-to-code" time into 3 groups: 0-59 minutes (n = 38), 60-119 minutes (n = 49), and 120 minutes or more (n = 35). The code-to-tPA time was compared among these groups, adjusting for age, sex, National Institutes of Health Stroke Scale (NIHSS) score, and race-ethnicity.
  
  
  RESULTS
  The average code-to-tPA time was 80 minutes in the 0-59 minutes group, 67 minutes in the 60-119 minutes group, and 52 minutes in the 120 minutes or more group (analysis of variance P < .0001). There was an average 28-minute difference (P = .021) between the 0-59 and 120 minutes or more groups.
  
  
  CONCLUSIONS
  There was a significant negative correlation between the LKW-to-code time and the code-to-tPA time that was independent of age, sex, NIHSS score, and race-ethnicity.
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Kyle C
authors.initials: KC
authors.lastname: Rossi
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: johnliangmd@gmail.com.
authors.forename: John W
authors.initials: JW
authors.lastname: Liang
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Natalie
authors.initials: N
authors.lastname: Wilson
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Stanley
authors.initials: S
authors.lastname: Tuhrim
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Mandip S
authors.initials: MS
authors.lastname: Dhamoon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Ischemic stroke; alteplase; cerebrovascular disease; quality improvement; tPA