Impact of the Extended Thrombolysis Time Window on the Proportion of Recombinant Tissue-Type Plasminogen Activator-Treated Stroke Patients and on Door-to-Needle Time
The European Cooperative Acute Stroke Study (ECASS) III extended the thrombolysis time window for patients with stroke from 3 to 4.5 hours after symptom onset. We investigated the effect of the extended thrombolysis time window on the proportion of recombinant tissue-type plasminogen activator-treat...
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| Veröffentlicht in: | Stroke (1970) 2011-10, Vol.42 (10), p.2838-2843 |
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| container_title | Stroke (1970) |
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| creator | MINNERUP, Jens WERSCHING, Heike BERND RINGELSTEIN, E SCHILLING, Matthias SCHÄBITZ, Wolf-Rüdiger WELLMANN, Jürgen BERGER, Klaus |
| description | The European Cooperative Acute Stroke Study (ECASS) III extended the thrombolysis time window for patients with stroke from 3 to 4.5 hours after symptom onset. We investigated the effect of the extended thrombolysis time window on the proportion of recombinant tissue-type plasminogen activator-treated stroke patients and on the time of treatment initiation after hospital arrival.
The present study was based on a prospective database of 93 hospitals of the Stroke Register of Northwestern Germany, which included 91 805 patients with ischemic stroke admitted between January 2007 and December 2009. Main outcome measures were the use of recombinant tissue-type plasminogen activator among patients with stroke and the door-to-needle time before and after the publication of ECASS III in September 2008 and subsequent changes of the German guidelines in May 2009.
Overall, 9262 patients (10.1%) were treated with recombinant tissue-type plasminogen activator. The proportion of thrombolyzed patients increased from 8.6% in 2007 to 11.7% in 2009. This increase was pronounced for patients admitted between 3 and 6 hours after symptom onset after the third quarter of 2008 (OR, 1.88; 95% CI, 1.24 to 2.85) and after the second and third quarters of 2009 (OR, 2.50; 95% CI, 1.69 to 3.69 and OR, 3.02; 95% CI, 2.07 to 4.41) compared with the first half year 2007. The proportion of patients with stroke with a door-to-needle time |
| doi_str_mv | 10.1161/strokeaha.111.616565 |
| format | Article |
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The present study was based on a prospective database of 93 hospitals of the Stroke Register of Northwestern Germany, which included 91 805 patients with ischemic stroke admitted between January 2007 and December 2009. Main outcome measures were the use of recombinant tissue-type plasminogen activator among patients with stroke and the door-to-needle time before and after the publication of ECASS III in September 2008 and subsequent changes of the German guidelines in May 2009.
Overall, 9262 patients (10.1%) were treated with recombinant tissue-type plasminogen activator. The proportion of thrombolyzed patients increased from 8.6% in 2007 to 11.7% in 2009. This increase was pronounced for patients admitted between 3 and 6 hours after symptom onset after the third quarter of 2008 (OR, 1.88; 95% CI, 1.24 to 2.85) and after the second and third quarters of 2009 (OR, 2.50; 95% CI, 1.69 to 3.69 and OR, 3.02; 95% CI, 2.07 to 4.41) compared with the first half year 2007. The proportion of patients with stroke with a door-to-needle time<60 minutes increased after publication of ECASS III (OR, 1.49; 95% CI, 1.37 to 1.63).
Results of ECASS III were rapidly implemented in routine stroke care. Concerns of a delay in recombinant tissue-type plasminogen activator treatment initiation after the extension of the thrombolysis time window were not confirmed.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/strokeaha.111.616565</identifier><identifier>PMID: 21852612</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Blood. Blood coagulation. Reticuloendothelial system ; Brain Ischemia - drug therapy ; Databases, Factual ; Female ; Fibrinolytic Agents - administration & dosage ; Fibrinolytic Agents - therapeutic use ; Germany ; Humans ; Infusions, Intravenous ; Male ; Medical sciences ; Middle Aged ; Neurology ; Pharmacology. Drug treatments ; Registries ; Stroke - drug therapy ; Thrombolytic Therapy - methods ; Time Factors ; Tissue Plasminogen Activator - administration & dosage ; Tissue Plasminogen Activator - therapeutic use ; Treatment Outcome ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2011-10, Vol.42 (10), p.2838-2843</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-74d06c2aa7161aa302167626a43b552c87b404fd39003f96432a73c8d615964a3</citedby><cites>FETCH-LOGICAL-c448t-74d06c2aa7161aa302167626a43b552c87b404fd39003f96432a73c8d615964a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24599340$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21852612$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MINNERUP, Jens</creatorcontrib><creatorcontrib>WERSCHING, Heike</creatorcontrib><creatorcontrib>BERND RINGELSTEIN, E</creatorcontrib><creatorcontrib>SCHILLING, Matthias</creatorcontrib><creatorcontrib>SCHÄBITZ, Wolf-Rüdiger</creatorcontrib><creatorcontrib>WELLMANN, Jürgen</creatorcontrib><creatorcontrib>BERGER, Klaus</creatorcontrib><title>Impact of the Extended Thrombolysis Time Window on the Proportion of Recombinant Tissue-Type Plasminogen Activator-Treated Stroke Patients and on Door-to-Needle Time</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>The European Cooperative Acute Stroke Study (ECASS) III extended the thrombolysis time window for patients with stroke from 3 to 4.5 hours after symptom onset. We investigated the effect of the extended thrombolysis time window on the proportion of recombinant tissue-type plasminogen activator-treated stroke patients and on the time of treatment initiation after hospital arrival.
The present study was based on a prospective database of 93 hospitals of the Stroke Register of Northwestern Germany, which included 91 805 patients with ischemic stroke admitted between January 2007 and December 2009. Main outcome measures were the use of recombinant tissue-type plasminogen activator among patients with stroke and the door-to-needle time before and after the publication of ECASS III in September 2008 and subsequent changes of the German guidelines in May 2009.
Overall, 9262 patients (10.1%) were treated with recombinant tissue-type plasminogen activator. The proportion of thrombolyzed patients increased from 8.6% in 2007 to 11.7% in 2009. This increase was pronounced for patients admitted between 3 and 6 hours after symptom onset after the third quarter of 2008 (OR, 1.88; 95% CI, 1.24 to 2.85) and after the second and third quarters of 2009 (OR, 2.50; 95% CI, 1.69 to 3.69 and OR, 3.02; 95% CI, 2.07 to 4.41) compared with the first half year 2007. The proportion of patients with stroke with a door-to-needle time<60 minutes increased after publication of ECASS III (OR, 1.49; 95% CI, 1.37 to 1.63).
Results of ECASS III were rapidly implemented in routine stroke care. Concerns of a delay in recombinant tissue-type plasminogen activator treatment initiation after the extension of the thrombolysis time window were not confirmed.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Brain Ischemia - drug therapy</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Germany</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Pharmacology. Drug treatments</subject><subject>Registries</subject><subject>Stroke - drug therapy</subject><subject>Thrombolytic Therapy - methods</subject><subject>Time Factors</subject><subject>Tissue Plasminogen Activator - administration & dosage</subject><subject>Tissue Plasminogen Activator - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkd1u1DAQhS0EokvhDRDyDeIqxX9xkstVWWhFRas2iMto1pmwhsRObS-wD8R74u4ucDU60nfmaOYQ8pKzM841fxtT8N8RNpAlP9Ncl7p8RBa8FKpQWtSPyYIx2RRCNc0JeRbjN8aYkHX5lJwIXpdCc7Egvy-nGUyifqBpg3T1K6HrsaftJvhp7cddtJG2dkL6xbre_6Te7cGb4Gcfks0yW2_RZNo6cCnDMW6xaHdzpkaIk3X-Kzq6NMn-gORD0QaElDPu9hfQG0gWXYoUXP-w_p3PTPLFJ8R-xH34c_JkgDHii-M8JZ_fr9rzi-Lq-sPl-fKqMErVqahUz7QRAFV-EIBkgutKCw1KrstSmLpaK6aGXjb5M0OjlRRQSVP3mpdZgTwlbw575-DvtxhTN9locBzBod_Grm5UzSWvZSbVgTTBxxhw6OZgJwi7jrPuoZ_urr29_rhaXiyz5N2hn2x7dQzYrifs_5n-FpKB10cAooFxCOCMjf85VTaNVEz-ATvGm9g</recordid><startdate>20111001</startdate><enddate>20111001</enddate><creator>MINNERUP, Jens</creator><creator>WERSCHING, Heike</creator><creator>BERND RINGELSTEIN, E</creator><creator>SCHILLING, Matthias</creator><creator>SCHÄBITZ, Wolf-Rüdiger</creator><creator>WELLMANN, Jürgen</creator><creator>BERGER, Klaus</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111001</creationdate><title>Impact of the Extended Thrombolysis Time Window on the Proportion of Recombinant Tissue-Type Plasminogen Activator-Treated Stroke Patients and on Door-to-Needle Time</title><author>MINNERUP, Jens ; WERSCHING, Heike ; BERND RINGELSTEIN, E ; SCHILLING, Matthias ; SCHÄBITZ, Wolf-Rüdiger ; WELLMANN, Jürgen ; BERGER, Klaus</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-74d06c2aa7161aa302167626a43b552c87b404fd39003f96432a73c8d615964a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Brain Ischemia - drug therapy</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Germany</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Pharmacology. Drug treatments</topic><topic>Registries</topic><topic>Stroke - drug therapy</topic><topic>Thrombolytic Therapy - methods</topic><topic>Time Factors</topic><topic>Tissue Plasminogen Activator - administration & dosage</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MINNERUP, Jens</creatorcontrib><creatorcontrib>WERSCHING, Heike</creatorcontrib><creatorcontrib>BERND RINGELSTEIN, E</creatorcontrib><creatorcontrib>SCHILLING, Matthias</creatorcontrib><creatorcontrib>SCHÄBITZ, Wolf-Rüdiger</creatorcontrib><creatorcontrib>WELLMANN, Jürgen</creatorcontrib><creatorcontrib>BERGER, Klaus</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MINNERUP, Jens</au><au>WERSCHING, Heike</au><au>BERND RINGELSTEIN, E</au><au>SCHILLING, Matthias</au><au>SCHÄBITZ, Wolf-Rüdiger</au><au>WELLMANN, Jürgen</au><au>BERGER, Klaus</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of the Extended Thrombolysis Time Window on the Proportion of Recombinant Tissue-Type Plasminogen Activator-Treated Stroke Patients and on Door-to-Needle Time</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2011-10-01</date><risdate>2011</risdate><volume>42</volume><issue>10</issue><spage>2838</spage><epage>2843</epage><pages>2838-2843</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>The European Cooperative Acute Stroke Study (ECASS) III extended the thrombolysis time window for patients with stroke from 3 to 4.5 hours after symptom onset. We investigated the effect of the extended thrombolysis time window on the proportion of recombinant tissue-type plasminogen activator-treated stroke patients and on the time of treatment initiation after hospital arrival.
The present study was based on a prospective database of 93 hospitals of the Stroke Register of Northwestern Germany, which included 91 805 patients with ischemic stroke admitted between January 2007 and December 2009. Main outcome measures were the use of recombinant tissue-type plasminogen activator among patients with stroke and the door-to-needle time before and after the publication of ECASS III in September 2008 and subsequent changes of the German guidelines in May 2009.
Overall, 9262 patients (10.1%) were treated with recombinant tissue-type plasminogen activator. The proportion of thrombolyzed patients increased from 8.6% in 2007 to 11.7% in 2009. This increase was pronounced for patients admitted between 3 and 6 hours after symptom onset after the third quarter of 2008 (OR, 1.88; 95% CI, 1.24 to 2.85) and after the second and third quarters of 2009 (OR, 2.50; 95% CI, 1.69 to 3.69 and OR, 3.02; 95% CI, 2.07 to 4.41) compared with the first half year 2007. The proportion of patients with stroke with a door-to-needle time<60 minutes increased after publication of ECASS III (OR, 1.49; 95% CI, 1.37 to 1.63).
Results of ECASS III were rapidly implemented in routine stroke care. Concerns of a delay in recombinant tissue-type plasminogen activator treatment initiation after the extension of the thrombolysis time window were not confirmed.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>21852612</pmid><doi>10.1161/strokeaha.111.616565</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Brain Ischemia - drug therapy Databases, Factual Female Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - therapeutic use Germany Humans Infusions, Intravenous Male Medical sciences Middle Aged Neurology Pharmacology. Drug treatments Registries Stroke - drug therapy Thrombolytic Therapy - methods Time Factors Tissue Plasminogen Activator - administration & dosage Tissue Plasminogen Activator - therapeutic use Treatment Outcome Vascular diseases and vascular malformations of the nervous system |
| title | Impact of the Extended Thrombolysis Time Window on the Proportion of Recombinant Tissue-Type Plasminogen Activator-Treated Stroke Patients and on Door-to-Needle Time |
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