Effects of Golden Hour Thrombolysis

Abstract

Quiz Ref ID Time to treatment with tissue plasminogen activator (tPA) is crucial to outcomes among patients with acute ischemic stroke.^1,2 Numerous attempts have been made to reduce the time from symptom onset to treatment (OTT).^3,4 However, many centers struggle to keep the time from arrival at the hospital to initiation of tPA (door-to-needle time) shorter than 60 minutes.^5,6 When prehospital times are added to in-hospital delays, an OTT within the first 60 minutes of symptom onset, termed the golden hour, seems out of reach for most patients. In fact, most patients undergoing routine care for stroke receive treatment rather late. In the Safe Implementation of Thrombolysis–Stroke Monitoring Study (SITS-MOST) registry,⁷ 10.6% of 6483 patients were treated within 90 minutes and only 1.4% within 60 minutes. The median OTT in the SITS–International Stroke Thrombolysis Register⁸ was 145 (interquartile range [IQR], 115-170) minutes. Structured approaches have been successful in increasing thrombolysis rates and shortening door-to-needle times.^9-11 Centers with greater numbers of tPA treatments per year tend to have shorter door-to-needle times compared with smaller centers.⁵ However, some of the centers with shortened door-to-needle times still have long prehospital times.^9,12