Vol 48, No 1 (2014)

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Is there a bad time for intravenous thrombolysis? The experience of Polish stroke centers

Michał Karliński1, Adam Kobayashi12, Piotr Sobolewski3, Paweł Lisewski4, Sławomir Romanowicz5, Waldemar Fryze6, Walenty Nyka7, Marcin Zięba8, Małgorzata Dorobek9, Anna Członkowska1
DOI: 10.1016/j.pjnns.2013.12.003
Neurol Neurochir Pol 2014;48(1):45-51.

Abstract

Background and purpose

The outcome in acute stroke strongly depends on patient-related issues, as well as on the availability of human and diagnostic resources. Our aim was to evaluate safety and effectiveness of intravenous alteplase for stroke according to the time of admission to the hospital.

Materials and methods

We analyzed the data of all acute stroke patients treated with alteplase between October 2003 and December 2010, contributed to the Safe Implementation of Thrombolysis for Stroke registry from 27 Polish stroke centers. According to the time of admission we distinguished between: (1) non-working days (Friday 14:30–Monday 08:00 plus national holidays); (2) out-of-office hours (non-working days plus 14:30–08:00 during working days); and (3) night hours (time from 23:00 to 06:00). Patients admitted during regular working hours (Monday 08:00–Friday 14:30, excluding national holidays) were used as the reference.

Results

Of 1330 patients, 448 (32.5%) were admitted on non-working days, 868 (65.3%) at out-of-office hours, and 105 (7.9%) during night hours. In multivariate logistic regression, none of the evaluated periods showed association with symptomatic intracranial hemorrhage, 7-day mortality, and neurological improvement ≥4 points in the National Institutes of Health Stroke Scale score at day 7. Patients admitted during night hours had lower odds (OR 0.53, 95% CI: 0.29–0.95, p=0.032) for achieving favorable outcome (modified Rankin Scale score 0–2).

Conclusions

There is no bad time for thrombolysis. Stroke centers should feel confident about the treatment outside regular working hours, irrespective of equipment and staff availability. However, it may be reasonable to pay additional attention during nighttime.

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Neurologia i Neurochirurgia Polska