Timeliness of Thrombolysis in Acute Ischemic Stroke Care

Thrombolysis within a narrow time window following acute ischaemic stroke dramatically reduces neuronal injury and improves functional outcomes. Treatment efficacy is closely linked to rapid diagnosis, prehospital notification and streamlined in-hospital pathways. Optimal systems integrate public education, emergency medical services prealert, immediate imaging and multidisciplinary stroke protocols to achieve door-to-needle times under 60 minutes, with leading centres reporting median times below 30 minutes. Barriers include delayed presentation, diagnostic uncertainty, resource constraints and inter-professional coordination challenges. Efforts to refine process metrics have underscored the importance of continuous quality improvement, capacity planning and targeted training to sustain rapid reperfusion delivery across diverse healthcare settings.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Timeliness of Thrombolysis in Acute Ischemic Stroke Care publication trend

The graph below shows the total number of articles in timeliness of thrombolysis in acute ischemic stroke care across all publications each year (not limited to Nature Index journals).

Technical terms

Thrombolysis: Pharmacological dissolution of intravascular clots using agents such as tissue plasminogen activator (tPA).

Door-to-needle time: Interval from patient arrival at hospital to initiation of thrombolytic therapy.

Onset-to-needle time: Total time from symptom onset to thrombolytic administration.

Reperfusion: Restoration of blood flow to ischaemic brain tissue following treatment.

Simulation training: Educational methodology using realistic clinical scenarios to enhance team performance and procedural proficiency.

References

1. Impact of the COVID‐19 pandemic on acute stroke care: An analysis of the 24‐month data from a comprehensive stroke center in Shanghai, China. CNS Neuroscience & Therapeutics (2023).
2. Evaluating the effects of simulation training on stroke thrombolysis: a systematic review and meta-analysis. Advances in Simulation (2024).
3. What would other emergency stroke teams do? Using explainable machine learning to understand variation in thrombolysis practice. European Stroke Journal (2023).
4. How can we improve stroke thrombolysis rates? A review of health system factors and approaches associated with thrombolysis administration rates in acute stroke care. Implementation Science (2015).
5. Stroke Code Improves Intravenous Thrombolysis Administration in Acute Ischemic Stroke. PLOS ONE (2014).
6. Provider perceptions of barriers to the emergency use of tPA for Acute Ischemic Stroke: A qualitative study. BMC Emergency Medicine (2011).
7. A modelling tool for capacity planning in acute and community stroke services. BMC Health Services Research (2016).
8. Thrombolysis in Stroke within 30 Minutes: Results of the Acute Brain Care Intervention Study. PLOS ONE (2016).
9. Prehospital Notification Procedure Improves Stroke Outcome by Shortening Onset to Needle Time in Chinese Urban Area. Aging and Disease (2018).