Not surprisingly, the first abstract presented to the media here at Stroke 2009 dealt with the perennial issue of tPA timing.
Dr. Jeffrey Saver, director of UCLA's Stroke Center, reported on his huge registry study which found that patients who arrived at hospitals within an hour of stroke symptom onset were more than twice as likely to get tPA as those who arrived in the second or third hour. About 30% of the 100,000+ patients studied arrived within that first hour.
The bad news, however, was that doctors took 15 minutes longer to actually treat these first-hour patients than those who arrived later, perhaps thinking they had a bit of a time cushion to ensure that treatment was the right decision. Current guidelines recommend a "door to needle" time for tPA of 60 minutes from hospital arrival-- and for these patients, the average time was 90 minutes.
"There's a natural tendency for physicians to say we have some extra time to learn about the nature of stroke and make a more deliberate decision...but we are trying to highlight (that for) patients who get to hospitals early, we need to match that effort, and treat those patients more quickly," Dr. Saver said. "For every ten minutes that tPA is delayed, one less patient benefits from it."