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Stroke

'Time is brain' after stroke, regardless of age and severity

Two recent studies highlight the importance of prompt, coordinated intervention after stroke. A meta-analysis confirms that intravenous thrombolysis is effective within 4.5 h of onset, irrespective of age (below or above 80 years) and stroke severity. Another study demonstrates successful reorganization of care through centralization of stroke services in England.

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References

  1. [No authors listed] Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N. Engl. J. Med. 333, 1581–1587 (1995).

  2. Lees, K. R. et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375, 1695–1703 (2010).

    Article  CAS  Google Scholar 

  3. Fonarow, G. C. et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation 123, 750–758 (2011).

    Article  CAS  Google Scholar 

  4. Bray, B. D. et al. Stroke thrombolysis in England: an age stratified analysis of practice and outcome. Age Ageing 42, 240–245 (2013).

    Article  Google Scholar 

  5. Emberson, J. et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet http://dx.doi.org/10.1016/S0140-6736(14)60584-5.

  6. Sandercock, P. et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third International Stroke Trial [IST-3]): a randomised controlled trial. Lancet 379, 2352–2363 (2012).

    Article  Google Scholar 

  7. Bray, B. D. et al. Bigger, faster? Associations between hospital thrombolysis volume and speed of thrombolysis administration in acute ischemic stroke. Stroke 44, 3129–3135 (2013).

    Article  CAS  Google Scholar 

  8. Bray, B. D. et al. Associations between the organisation of stroke services, process of care, and mortality in England: prospective cohort study. BMJ 346, f2827 (2013).

    Article  Google Scholar 

  9. Morris, S. et al. Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis. BMJ 349, g4757 (2014).

    Article  Google Scholar 

  10. Muller-Barna, P. et al. TeleStroke units serving as a model of care in rural areas: 10-year experience of the TeleMedical Project for integrative stroke care. Stroke 45, 2739–2744 (2014).

    Article  Google Scholar 

Download references

Acknowledgements

H.J A. has received funding for the TEMPiS network from the Bavarian health insurance companies, the Bavarian Ministry of Labour and Social Affairs, the German Foundation for Stroke Aid and the German Federal Ministry of Education and Research (BMBF), as well as funding for the STEMO project from the 'Zukunftsfonds Berlin', and funding for the INSPiRE-TMS trial by the Federal Ministry of Education and Research (BMBF) via the grant Center for Stroke Research Berlin (01 EO 0801). J.S. has received funding for the Mismatch24 study from the BMBF via the grant Center for Stroke Research Berlin (01 EO 0801), as well as funding for the Stroke Unit Plus Study via a grant from the Corona Foundation.

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Correspondence to Heinrich J. Audebert.

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H.J.A. has received consultancy honoraria from Lundbeck Pharma, Pfizer and Bayer Vital, as well as speaker's honoraria from Takeda Pharma, Boehringer Ingelheim, Lundbeck, Bayer Vital, UCB, Pfizer, Bristol-Myers Squibb and Sanofi-Synthélabo. J.S. has received consultancy and speaker's honoraria from Boehringer Ingelheim, Bayer Vital, BMS, Maquet, Pfizer, Paion, Sanofi-Synthélabo, Takeda Pharma and UCB.

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Audebert, H., Sobesky, J. 'Time is brain' after stroke, regardless of age and severity. Nat Rev Neurol 10, 675–676 (2014). https://doi.org/10.1038/nrneurol.2014.194

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