Coagulation

Study reveals paradoxical delay in thrombolysis treatment


Stroke patients who arrive early to hospital are more likely to experience a longer delay in receiving thrombolysis compared to those who arrive later, a study shows.

The retrospective analysis of stroke admissions at the Wollongong Hospital in the Illawarra region over a three year period found that for every 30-minute delay in hospital arrival, there was a reduction in door-to-needle-time (DNT) of 13 minutes.

The finding remained statistically significant when the research team accounted for the patient’s age, gender, NIHSS score and arrival to CT time.

“Our results are the first documented evidence of such association within Australia but similar results have been noted in other countries,” the research team led by stroke registrar Dr Udit Nindra said.

“A possible lack of urgency when it comes to  acute stroke management … may be influenced negatively by the perception of a 4.5 hour time window,” they suggested.

“Intravenous thrombolysis is more beneficial the earlier it is initiated … there is a possibility that this paradoxical delay in treatment is causing worsening patient outcomes but the extent to which this is, is not possible to determine,” they added.

As a way of counteracting their paradoxical finding the team are running clinical education sessions with stroke first responders with an emphasis on the motto ‘time is brain’ in which they aim to reduce the DNT to less than 80 minutes.

The findings were presented at the annual meeting of the Australian & New Zealand Association of Neurologists (ANZAN) in Sydney on 23 May.

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