{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:06:19Z","timestamp":1753891579376,"version":"3.41.2"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> There is emphasis on timely administration of thrombolysis and clot retrieval but not antithrombotic therapy within 48 h for ischemic stroke (frequency of 64% in Australia and 97% in North America). We planned to assess the time metrics and variables associated with delaying antithrombotics (antiplatelet and anticoagulant therapy) administration.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This was a retrospective study at Monash Health over 12 months in 2015. We plotted the cumulative event and mapped the key drivers (dimensionless variable Shapley value\/SV) of antithrombotics.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> There were 42 patients with transient ischemic attack\/TIA and 483 with ischemic stroke [mean age was 71.8 \u00b1 15.4; 56.0% male; nil by mouth (NBM) 74.5 and 49.3% of patients received \u201cstat\u201d (immediate and one off) dose antithrombotics]. The median time to imaging for the patients who did not have stroke code activated was 2.3 h (IQR 1.4\u20133.7), from imaging to dysphagia screen was 14.6 h (IQR 6.2\u201320.3), and from stopping NBM to antithrombotics was 1.7 h (IQR 0\u201316.5). TIA patients received antithrombotics earlier than those with ischemic stroke (90.5 vs. 86.5%, <jats:italic>p<\/jats:italic> = 0.01). Significant variables in regression analysis for time to antithrombotics were time to dysphagia screen (\u03b2 0.20 \u00b1 0.03, SV = 3.2), nasogastric tube (\u03b2 19.8 \u00b1 5.9, SV = \u22120.20), Alteplase (\u03b2 8.6 \u00b1 3.6, SV = \u22121.9), stat dose antithrombotic (\u03b2 \u221218.9 \u00b1 2.9, SV = \u221210.8) and stroke code (\u03b2 \u22125.9 \u00b1 2.5, SV = 2.8). The partial correlation network showed that the time to antithrombotics increased with delay in dysphagia screen (coefficient = 0.33) and decreased if \u201cstat\u201d dose of antithrombotics was given (coefficient = \u22120.32).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The proportion of patients receiving antithrombotics within 48 h was higher than previously reported in Australia but remained lower than the standard achieved in North American hospitals. Our process map and network analysis show avenues to shorten the time to antithrombotic.<\/jats:p>","DOI":"10.3389\/fneur.2021.651869","type":"journal-article","created":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T05:25:01Z","timestamp":1623043501000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Network Mapping of Time to Antithrombotic Therapy Among Patients With Ischemic Stroke and Transient Ischemic Attack (TIA)"],"prefix":"10.3389","volume":"12","author":[{"given":"Thanh G.","family":"Phan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Clissold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaloo","family":"Singhal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Van","family":"Ly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andy","family":"Lim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Vuong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stella","family":"Ho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsea","family":"Matley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Talvika","family":"Kooblal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1016\/S0140-6736(11)61485-2","article-title":"Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial","volume":"378","author":"Middleton","year":"2011","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1016\/S0140-6736(16)30468-8","article-title":"Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials","volume":"388","author":"Rothwell","year":"2016","journal-title":"Lancet."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1161\/01.STR.31.6.1240","article-title":"Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40,000 randomized patients from the Chinese acute stroke trial and the international stroke trial. 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