REBEL Cast Ep84 - By Salim Rezaie - June 18, 2020
Paper: Man S et al. Association Between Thrombolytic Door-to-Needle time and 1-Year Mortality and Readmission in Patients with Acute Ischemic Stroke. JAMA 2020. PMID: 32484532
"Clinical Question: Is shorter door-to-needle times with tPA for acute ischemic stroke in patients ≥65 years associated with improved long-term outcomes?
Author Conclusion: “Among patients aged 65 years or older with acute ischemic stroke who were treated with tissue plasminogen activator, shorter door-to-needle times were associated with lower all-cause mortality and lower all-cause readmission at 1 year. These findings support efforts to shorten time to thrombolytic therapy.”
Clinical Take Home Point: I disagree with the authors conclusions of this trial. It is essentially impossible to draw any conclusions from this observational trial. Pushing for more rapid administration of tPA will include more stroke mimic cases making the earlier times look better and the more difficult patients with more comorbid disease (HTN) look worse in the later times of administration. Additionally, all the long-term outcomes were barely statistically significant, almost crossing"