Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice: retrospective analysis of hospital quality assurance data with comparison with results from randomised clinical trials.

STUDY QUESTION Does thrombolytic therapy for acute ischaemic stroke have a similar time dependent benefit/risk ratio in clinical practice to that seen in pooled analyses of randomised clinical trials? SUMMARY ANSWER In patients with acute ischaemic stroke treated with thrombolytic therapy in routine clinical practice, the time dependent odds ratios for mortality and favourable early outcome are close to the values found in a pooled analysis of randomised clinical trials. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Pooled analysis of randomised clinical trials of recombinant tissue plasminogen activator in patients with stroke has shown a time related decreasing benefit/risk ratio with increasing time between onset of stroke and treatment up to 4.5 hours. In an unselected cohort of patients with acute ischaemic stroke in clinical practice, there was also a clear association between shorter onset to treatment with thrombolytic therapy and better functional outcome, suggesting a similar magnitude to that observed in clinical trials. [ABSTRACT FROM AUTHOR]