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Golden Hour Thrombolysis in Acute Ischemic Stroke: The Changing Pattern in South Korea

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초록

Intravenous tissue plasminogen activator (IV-tPA) is pivotal for the treatment of acute ischemic stroke; however, the benefit of IV-tPA treatment declines rapidly soon after stroke onset.1 These results support intensive efforts to reduce both onset-totreatment (OTT) time and door-to-treatment (DTT) time and serve as a basis for establishing an in-hospital and prehospital stroke care system. As these efforts require substantial expenditures of labor and capital, more real-world data are needed to assess the effect of golden hour thrombolysis for acute ischemic stroke. Moreover, understanding the current status and secular changes in IV-tPA treatment will be important to establish an appropriate stroke care system in the future. Therefore, we investigated the effect of golden hour thrombolysis and secular changes in time-to-treatment variables for IV-tPA for acute ischemic stroke by analyzing a prospective registry of 16 stroke centers in South Korea.

Abstract

Intravenous tissue plasminogen activator (IV-tPA) is pivotal for the treatment of acute ischemic stroke; however, the benefit of IV-tPA treatment declines rapidly soon after stroke onset.1 These results support intensive efforts to reduce both onset-totreatment (OTT) time and door-to-treatment (DTT) time and serve as a basis for establishing an in-hospital and prehospital stroke care system. As these efforts require substantial expenditures of labor and capital, more real-world data are needed to assess the effect of golden hour thrombolysis for acute ischemic stroke. Moreover, understanding the current status and secular changes in IV-tPA treatment will be important to establish an appropriate stroke care system in the future. Therefore, we investigated the effect of golden hour thrombolysis and secular changes in time-to-treatment variables for IV-tPA for acute ischemic stroke by analyzing a prospective registry of 16 stroke centers in South Korea.

참고문헌 (7)

  1. Kim JT, "Treatment with tissue plasminogen activator in the golden hour and the shape of the 4.5-hour time-benefit curve in the national United States get with the guidelines-stroke population", Circulation, 135, pp.128~139 (2017)
  2. Emberson J, "Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials", Lancet, 384, pp.1929~1935 (2014)
  3. Tsivgoulis G, "Intravenous thrombolysis for ischemic stroke in the golden hour : propensity-matched analysis from the SITS-EAST registry", J Neurol, 264, pp.912~920 (2017)
  4. Fonarow GC, "Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative", JAMA, 311, pp.1632~1640 (2014)
  5. Kamal N, "Improving door-to-needle times for acute ischemic stroke : effect of rapid patient registration, moving directly to computed tomography, and giving alteplase at the computed tomography scanner", Circ Cardiovasc Qual Outcomes, 10, pp.e003242~ (2017)
  6. Kassardjian CD, "In-patient code stroke : a quality improvement strategy to overcome knowledge-to-action gaps in response time", Stroke, 48, pp.2176~2183 (2017)
  7. Heo JH, "A computerized in-hospital alert system for thrombolysis in acute stroke", Stroke, 41, pp.1978~1983 (2010)

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