Abstract TMP24: Thrombolytics With ≤30 Minutes Door-to-Needle Time in Acute Ischemic Stroke: How Fast is Too Fast?

Abstract

Introduction: Current Phase III of the American Heart Association Target Initiative aims to achieve secondary goals of door to-needle-times within 30 minutes in ≥50% of acute ischemic stroke patients. We sought to evaluate the influence of non-institutional factors (namely presenting patient characteristics) on administration times, safety, and feasibility of thrombolytics within ≤30 minutes of presentation. Method: A single center, retrospective study from March 2018 to March 2023 was conducted yielding 179 patients who received IV thrombolytic for suspected acute ischemic stroke. Patients were dichotomized into those treated within 30 minutes and >30 minutes. A univariate analysis using Chi-squared test of proportions (or Fisher exact when appropriate) was used to compare the patient characteristics on presentation and a multivariate logistic regression was utilized to explore independent predictors. Results: Of a total of 176 patients (after excluding patients with missing data), 60% (n=105) were ≤30 minutes. Age, gender, past medical history, last known well time and admission modified ranking score did not influence thrombolytic administration time (table 1). However, a presenting NIH stroke score of >4 was associated with a 2.5 OR (1.19-5.23) (p=0.0151) of achieving < 30min times. Although a higher rate of intracerebral hemorrhage was noted in the >30 minutes group, this was not statistically significant (11% vs 6.6%; p=0.283). Conclusion: In our study, acute thrombolytic within 30 minutes was feasible, safe, and only influenced by higher NIHSS. Institutional processes remain the mainstay of achieving this target.