{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:41:28Z","timestamp":1765888888462,"version":"3.41.2"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,5,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The benefit of intravenous thrombolysis is time dependent. It remains unclear, however, whether dramatic shortening of door\u2010to\u2010needle time (DNT) among different types of hospitals nationwide does not compromise safety and still improves outcome.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Multifaceted intervention to shorten DNT was introduced at a national level, and prospectively collected data from a registry between 2004 and 2019 were analyzed. Generalized estimating equation was used to identify the association between DNT and outcomes independently from prespecified baseline variables. The primary outcome was modified Rankin score 0 to 1 at 3\u00a0months, and secondary outcomes were parenchymal hemorrhage\/intracerebral hemorrhage (ICH), any ICH, and death. Of 31\u00a0316 patients treated with intravenous thrombolysis alone, 18\u00a0861 (60%) had available data: age 70\u00b113 years, National Institutes of Health Stroke Scale at baseline (median, 8; interquartile range, 5\u201314), and 45% men. DNT groups 0 to 20 minutes, 21 to 40 minutes, 41 to 60 minutes, and &gt;60\u00a0minutes had 3536 (19%), 5333 (28%), 4856 (26%), and 5136 (27%) patients. National median DNT dropped from 74\u00a0minutes in 2004 to 22\u00a0minutes in 2019. Shorter DNT had proportional benefit: it increased the odds of achieving modified Rankin score 0 to 1 and decreased the odds of parenchymal hemorrhage\/ICH, any ICH, and mortality. Patients with DNT \u226420 minutes, 21 to 40 minutes, and 41 to 60\u00a0minutes as compared with DNT &gt;60\u00a0minutes had adjusted odds ratios for modified Rankin score 0 to 1 of the following: 1.30 (95% CI, 1.12\u20131.51), 1.33 (95% CI, 1.15\u20131.54), and 1.15 (95% CI, 1.02\u20131.29), and for parenchymal hemorrhage\/ICH: 0.57 (95% CI, 0.45\u20130.71), 0.76 (95% CI, 0.61\u20130.94), 0.83 (95% CI, 0.70\u20130.99), respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Ultrashort initiation of thrombolysis is feasible, improves outcome, and makes treatments safer because of fewer intracerebral hemorrhages. Stroke management should be optimized to initiate thrombolysis as soon as possible optimally within 20\u00a0minutes from arrival to a hospital.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.023524","type":"journal-article","created":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T09:15:52Z","timestamp":1652692552000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Ultrashort Door\u2010to\u2010Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7458-5166","authenticated-orcid":false,"given":"Robert","family":"Mikul\u00edk","sequence":"first","affiliation":[{"name":"International Clinical Research Center and Department of Neurology St. Anne\u2019s University Hospital in Brno Czech Republic"},{"name":"Faculty of Medicine at Masaryk University Brno Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5049-5844","authenticated-orcid":false,"given":"Michal","family":"Bar","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Ostrava and Faculty of Medicine at University Ostrava Ostrava Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvie","family":"B\u011bla\u0161kov\u00e1","sequence":"additional","affiliation":[{"name":"International Clinical Research Center and Department of Neurology St. Anne\u2019s University Hospital in Brno Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4005-804X","authenticated-orcid":false,"given":"David","family":"\u010cern\u00edk","sequence":"additional","affiliation":[{"name":"Comprehensive Stroke Center \u2010 Department of Neurology Masaryk Hospital Ust\u00ed nad Labem \u2010 KZ a.s. Ust\u00ed nad Labem Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5748-0127","authenticated-orcid":false,"given":"Jan","family":"Fiksa","sequence":"additional","affiliation":[{"name":"Department of Neurology First Faculty of Medicine and General University Hospital, Charles University Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7238-7724","authenticated-orcid":false,"given":"Roman","family":"Herzig","sequence":"additional","affiliation":[{"name":"Comprehensive Stroke Center University Hospital Hradec Kr\u00e1lov\u00e9Charles University Faculty of Medicine in Hradec Kr\u00e1lov\u00e9 Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0361-0256","authenticated-orcid":false,"given":"Ren\u00e9","family":"Jura","sequence":"additional","affiliation":[{"name":"Faculty of Medicine at Masaryk University Brno Czech Republic"},{"name":"Department of Neurology University Hospital Brno Brno Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2096-2798","authenticated-orcid":false,"given":"Lubom\u00edr","family":"Jur\u00e1k","sequence":"additional","affiliation":[{"name":"Neurocenter Regional Hospital Liberec Liberec Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1316-5782","authenticated-orcid":false,"given":"Luk\u00e1\u0161","family":"Kle\u010dka","sequence":"additional","affiliation":[{"name":"Department of Neurology Town Hospital Ostrava Ostrava Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4857-6618","authenticated-orcid":false,"given":"Ji\u0159\u00ed","family":"Neumann","sequence":"additional","affiliation":[{"name":"Department of Neurology Chomutov Hospital, KZ a.s. 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