ArticleBMJ (Clinical research ed.)2014
Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice: retrospective analysis of hospital quality assurance data with comparison with results from randomised clinical trials.
Article in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
40 citing papers in PubMed, 1 synthesis or guideline pooled it, 88 citations in OpenAlex.
- Statin Use and Outcomes of Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis: A Systematic Review and Meta-Analysis.Frontiers in neurology · 2021Pooled it
- Comparing 5G mobile stroke unit and emergency medical service in patients acute ischemic stroke eligible for t-PA treatment: A prospective, single-center clinical trial in Ya'an, China.Brain and behavior · 2023Trial
- Delayed Care in Self-Presenting Stroke Patients: Real-World Data on Process Delays-Comparing Process Times Between Emergency Medical Services and Self-Presentation.Journal of clinical medicine · 2026Article
- Article
- Outcome of endovascular stroke therapy in a large mandatory stroke-registry.Neurological research and practice · 2023Article
- [Comparison of acute stroke care pathways-A qualitative multicenter study in three referring hospitals of a stroke network].Der Nervenarzt · 2023Article
- Getting the guts to expand stroke treatment: The potential for microbiome targeted therapies.CNS neuroscience & therapeutics · 2023Review
- The central role of peripheral inflammation in ischemic stroke.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2023Review
- Contemplating IL-6, a double-edged sword cytokine: Which side to use for stroke pathology?CNS neuroscience & therapeutics · 2023Review
- The Role of Concomitant Nrf2 Targeting and Stem Cell Therapy in Cerebrovascular Disease.Antioxidants (Basel, Switzerland) · 2022Review
- Engaging social activities prevent stroke and myocardial infraction by raising awareness of warning symptoms: A cross-sectional survey study.Frontiers in public health · 2022Article
- Therapeutic effects of stem cells in different body systems, a novel method that is yet to gain trust: A comprehensive review.Bosnian journal of basic medical sciences · 2021Review
- [Telemedicine in Stroke Care].Der Nervenarzt · 2021Article
- CT Angiography Manual Multiplanar Vessel Diameter Measurement vs. Semiautomated Perpendicular Area Minimal Caliber Computation of Internal Carotid Artery Stenosis.Frontiers in cardiovascular medicine · 2021Article
- Stroke gets in your eyes: stroke-induced retinal ischemia and the potential of stem cell therapy.Neural regeneration research · 2020Review
- Penumbra-based radiomics signature as prognostic biomarkers for thrombolysis of acute ischemic stroke patients: a multicenter cohort study.Journal of neurology · 2020Article
- Risk Factors Associated with Outcomes of Recombinant Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke.International journal of environmental research and public health · 2020Article
- Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study.Neuropsychiatric disease and treatment · 2020Article
- Development and validation of the Heidelberg Neurological Triage System (HEINTS).Journal of neurology · 2019Observational
- Knowledge and Poor Understanding Factors of Stroke and Heart Attack Symptoms.International journal of environmental research and public health · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo study the time dependent effectiveness of thrombolytic therapy for acute ischaemic stroke in daily clinical practice.
designA retrospective cohort study using data from a large scale, comprehensive population based state-wide stroke registry in Germany.
settingAll 148 hospitals involved in acute stroke care in a large state in southwest Germany with 10.4 million inhabitants.
participantsData from 84,439 patients with acute ischaemic stroke were analysed, 10,263 (12%) were treated with thrombolytic therapy and 74,176 (88%) were not treated.
main outcome measuresPrimary endpoint was the dichotomised score on a modified Rankin scale at discharge ("favourable outcome" score 0 or 1 or "unfavourable outcome" score 2-6) analysed by binary logistic regression. Patients treated with recombinant tissue plasminogen activator (rtPA) were categorised according to time from onset of stroke to treatment. Analogous analyses were conducted for the association between rtPA treatment of stroke and in-hospital mortality. As a co-primary endpoint the chance of a lower modified Rankin scale score at discharge was analysed by ordinal logistic regression analysis (shift analysis).
resultsAfter adjustment for characteristics of patients, hospitals, and treatment, rtPA was associated with better outcome in a time dependent pattern. The number needed to treat ranged from 4.5 (within first 1.5 hours after onset; odds ratio 2.49) to 18.0 (up to 4.5 hours; odds ratio 1.26), while mortality did not vary up to 4.5 hours. Patients treated with rtPA beyond 4.5 hours (including mismatch based approaches) showed a significantly better outcome only in dichotomised analysis (odds ratio 1.25, 95% confidence interval 1.01 to 1.55) but the mortality risk was higher (1.45, 1.08 to 1.92).
conclusionThe effectiveness of thrombolytic therapy in daily clinical practice might be comparable with the effectiveness shown in randomised clinical trials and pooled analysis. Early treatment was associated with favourable outcome in daily clinical practice, which underlines the importance of speeding up the process for thrombolytic therapy in hospital and before admission to achieve shorter time from door to needle and from onset to treatment for thrombolytic therapy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.