From the Guidelines
The door-to-needle time should be within 60 minutes from hospital arrival for patients eligible for intravenous rtPA, as recommended by the American Heart Association/American Stroke Association guidelines 1. This recommendation is based on the guidelines for the early management of patients with acute ischemic stroke, which emphasize the importance of timely treatment to improve outcomes. The guidelines suggest that benefit of therapy is time-dependent, and treatment should be initiated as quickly as possible. Key points to consider include:
- Intravenous rtPA (0.9 mg/kg, maximum dose 90 mg) is recommended for selected patients who may be treated within 3 hours of onset of ischemic stroke 1.
- The eligibility criteria for treatment should be carefully reviewed, including factors such as blood pressure, medical history, and imaging evidence of ischemic injury 1.
- While a door-to-needle time of < 30 minutes is ideal, the recommended target is within 60 minutes from hospital arrival 1. It is essential to note that these recommendations are based on the best available evidence and should be individualized based on a person's medical history, current health status, and specific conditions. Healthcare decisions should be made in consultation with a qualified healthcare provider, taking into account the latest guidelines and evidence-based practices 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Door-to-Needle Time Recommendations
- The recommended door-to-needle time is 60 minutes or less 2, 3.
- However, it is ideal to achieve a door-to-needle time of less than 30 minutes if possible.
- Studies have shown that fewer than 30% of acute ischemic stroke patients who receive tissue plasminogen activator (tPA) are treated within the guideline-recommended door-to-needle times 2.
Factors Affecting Door-to-Needle Time
- Prehospital factors such as patient-related factors, poor recognition of stroke symptoms, and complex psychosocial factors can contribute to delays 4.
- In-hospital delays can be attenuated by having well-defined rapid triage pathways, defined stroke teams, single-call stroke team activation, established code stroke protocols, rapid access to diagnostic imaging, and laboratory services 4.
- Prenotification of regional stroke centers by paramedics is strongly associated with shorter door-to-needle times 4.
Improving Door-to-Needle Times
- The American Heart Association/American Stroke Association's Target: Stroke initiative aims to improve door-to-needle times by implementing 10 key strategies, including emergency medical service prenotification, activating the stroke team with a single call, and rapid acquisition and interpretation of brain imaging 2.
- A national quality improvement initiative, such as the one described in 3, can improve door-to-needle times and clinical outcomes in acute ischemic stroke patients.
- Implementation of such initiatives has been associated with improved timeliness of tPA administration, lower in-hospital mortality, and fewer symptomatic intracranial hemorrhages 3.