For stroke victims, 15 minutes can mean the difference between life and death, a new study finds.
Rapid treatment with a clot-dissolving drug reduces stroke patients' risk of in-hospital death and increases their chances of being able to walk and return home when they leave the hospital, according to the study, published in the June 19 issue of the Journal of the American Medical Association.
"These findings support intensive efforts to accelerate patient presentation and to streamline regional and hospital systems of acute stroke care to compress [onset to treatment] times," Dr. Jeffrey Saver, of the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues said in a journal news release.
Researchers examined data from more than 58,000 patients who suffered an ischemic stroke (in which blood flow to the brain is blocked) and were treated with clot-dissolving tissue plasminogen activators (tPA) within four and a half hours of the onset of stroke symptoms. The patients were treated at nearly 1,400 U.S. hospitals between 2003 and 2012.
The median time between symptom onset and treatment was two hours and 24 minutes. Nine percent of patients were treated within 90 minutes of symptom onset; 77 percent were treated within 91 to 180 minutes of stroke symptoms; and about 14 percent went 181 to 270 minutes between the start of symptoms and treatment.
Factors most strongly associated with shorter onset-to-treatment time included greater stroke severity, ambulance arrival and arrival at the hospital during regular hours.
Nearly 9 percent of the patients died in the hospital, 5 percent had bleeding inside the skull (intracranial hemorrhage), 33 percent could walk when they were released from the hospital and 38 percent were discharged to their home.
For every 15-minute faster start of tPA therapy, patients were less likely to die or have an intracranial hemorrhage, and were more likely to walk and be sent home when discharged from the hospital, according to the study.
For example, patients with an onset-to-treatment time of 90 minutes were 26 percent less likely to die, 28 percent less likely to have an intracranial hemorrhage, 51 percent more likely to be able to walk and 33 percent more likely to be discharged to home, compared to those with an onset-to-treatment time of 181 to 270 minutes.