Temporal Trends and Outcomes of Acute Ischemic Stroke Thrombolysis: More than a Decade of Experience from a Tertiary Care Stroke Center

Q: What are the key findings of this study?

Intravenous thrombolysis reduced median NIHSS from 6 to 2 (p<0.001) with 10.7% in-hospital mortality, while door-to-needle time ≥60 min did not predict death (OR 0.60, 95% CI 0.31-1.13; p=0.117).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke (n=428). Intervention: Door-to-needle time ≥60 minutes in intravenous thrombolysis (alteplase or tenecteplase) vs. Door-to-needle time <60 minutes. Primary outcome: In-hospital all-cause mortality (OR 0.60, 95% CI 0.31-1.13, p=0.117).

Q: What does this research mean for the field?

Intravenous thrombolysis for acute ischemic stroke is associated with significant neurological improvement (reducing median NIHSS from 6 to 2), with in-hospital mortality driven by baseline stroke severity rather than door-to-needle time. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kapil Gangadhar Zirpe; Sushma Kirtikumar Gurav; Prajakta Pote; Sunil Bandishti; Santosh M Sontakke; Lomesh Bhirud; Abhijit Manikrao Deshmukh; Anand Mohanlal Tiwari; Upendrakumar S Kapse; Pranav Mahadeokar; Avinash Naniwadekar; Ashish Nandi; Natalie Grant; Simon Grant; RS Wadia

doi:10.5005/jp-journals-10071-25286

October 23, 2026Indian Journal of Critical Care MedicineOpen Access

Temporal Trends and Outcomes of Acute Ischemic Stroke Thrombolysis: More than a Decade of Experience from a Tertiary Care Stroke Center

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Key result

IV thrombolysis improves neurological deficits by ~4 points, while delayed door-to-needle time is not linked to mortality.

OR 0.60
95% CI 0.31-1.13
P=0.117
n=428

Why the study?

Long-term Indian data evaluating temporal trends in intravenous thrombolysis workflows and outcomes for acute ischemic stroke remain limited.

What are the temporal trends in thrombolysis workflow metrics and independent predictors of in-hospital mortality and length of stay in acute ischemic stroke patients undergoing intravenous thrombolysis in India?

Key Points

To evaluate temporal trends in intravenous thrombolysis workflow parameters and clinical outcomes in acute ischemic stroke, and to determine independent predictors of in-hospital mortality and length of stay.
Retrospective observational study analyzing consecutive acute ischemic stroke patients receiving intravenous thrombolysis at a tertiary care center in Pune, India, between 2015 and 2025 (N=428 treated out of 4,211 admissions).
Recorded demographic factors, workflow intervals (symptom-to-door, door-to-physician, door-to-imaging, and door-to-needle times), and clinical outcomes.
Identified independent predictors of in-hospital mortality and length of hospital stay using multivariable logistic and linear regression models.
Neurological status improved significantly following thrombolysis, with median baseline National Institutes of Health Stroke Scale scores dropping from 6 (IQR: 4–12) to 2 (IQR: 1–6; p < 0.001), and 42.7% achieving an improvement of ≥4 points.
Overall in-hospital mortality was 10.7% (46/428), and a door-to-needle time ≥60 minutes was not significantly associated with mortality (OR: 0.60, 95% CI: 0.31–1.13; p = 0.117).

Study Design

Type

Observational (n=428)

Multicenter

No

Structured PICO

What are the temporal trends in thrombolysis workflow metrics and independent predictors of in-hospital mortality and length of stay in acute ischemic stroke patients undergoing intravenous thrombolysis in India?

P

Population

428 adults (median age 63 years, IQR 54-72) presenting with acute ischemic stroke within 4.5 hours of symptom onset who received intravenous thrombolysis at a single Indian tertiary care center, followed during index hospitalization (median length of stay 8 days).

E

Exposure

Intravenous thrombolysis administered within 4.5 hours of symptom onset (among 398 patients with available agent data, 31.4% received intravenous alteplase and 68.6% received intravenous tenecteplase).

O

Outcome

In-hospital all-cause mortality during the index hospitalizationhard clinical

Main Result

Odds Ratio: 0.6 (95% CI 0.31–1.13)

Absolute Event Rate: 8.1% vs 12.8%

p-value: p=0.117

In an 11-year Indian tertiary care cohort of 428 acute ischemic stroke patients receiving IV thrombolysis, treatment yielded significant neurological improvement (median NIHSS decreasing from 6 to 2) with 10.7% in-hospital mortality driven independently by baseline stroke severity and chronic kidney disease rather than door-to-needle time.

Limitations

Single-center retrospective observational design subject to selection bias, residual confounding, and incomplete data capture
Confounding by indication as more severe strokes were prioritized for shorter door-to-needle times
Neurological (NIHSS) and functional (mRS) outcomes were assessed by treating clinicians rather than blinded independent evaluators
Functional outcome was assessed at hospital discharge rather than the standard 90-day follow-up
Missing post-thrombolysis NIHSS data (~20%) required multiple imputation
Relatively small number of in-hospital deaths (46 events) limited statistical power to detect modest mortality differences by door-to-needle time
Single-center, retrospective observational design
No formal a priori sample size calculation performed
Missing post-thrombolysis NIHSS data (~20%, n ≈ 71) requiring multiple imputation

Implication

May support IV thrombolysis in Indian centers; leaves open door-to-needle time effects on mortality.

Abstract

Background: Acute ischemic stroke (AIS) is a major contributor to mortality and disability in India.Timely intravenous thrombolysis is the cornerstone of reperfusion therapy; however, long-term Indian data evaluating temporal trends in thrombolysis workflows and outcomes remain limited.Objectives: To evaluate temporal trends in key intravenous thrombolysis workflow metrics and clinical outcomes among patients with AIS treated at a tertiary care stroke center in India, and to identify independent predictors of in-hospital mortality and hospital length of stay (LOS).Patients and methods: This retrospective observational study analyzed consecutive AIS patients who underwent intravenous thrombolysis at a tertiary care center in Pune, India, between 2015 and 2025.Demographic characteristics, workflow metrics, neurological outcomes, functional status, and mortality were evaluated.Workflow parameters included symptom-to-door time (STDt), door-to-physician time (DTPt), door-toimaging time (DTIt), and door-to-needle time (DTNt).Predictors of mortality and hospital LOS were assessed using multivariable regression analyses.Results: Among 4,211 AIS admissions, 428 patients received thrombolysis.Median age was 63 years and baseline National Institutes of Health Stroke Scale (NIHSS) was 6. Median STDt, DTPt, DTIt, and DTNt were 85, 5, 20, and 60 minutes, respectively.Significant neurological improvement was observed following thrombolysis, with NIHSS decreasing from 6 to 2 (p < 0.001).Overall, in-hospital mortality was 10.7%.Door-to-needle time ≥60 minutes was not significantly associated with mortality [odds ratio (OR): 0.60, 95% confidence interval (CI): 0.31-1.13;p = 0.117].Baseline NIHSS independently predicted mortality (adjusted OR: 1.13, 95% CI: 1.07-1.20;p < 0.001).Higher baseline NIHSS was independently associated with longer LOS, whereas early neurological improvement predicted shorter hospitalization.National Institutes of Health Stroke Scale change demonstrated good discrimination for mortality prediction [area under the curve (AUC): 0.810].Conclusion: Intravenous thrombolysis was associated with significant neurological improvement with acceptable mortality outcomes in AIS.Baseline stroke severity remained independently associated with in-hospital mortality, while workflow optimization may improve hospitalization outcomes in Indian stroke centers.

Discussion

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Cite This Study

Zirpe et al. (2026) conducted an observational in Acute ischemic stroke (n=428). Door-to-needle time ≥60 minutes in intravenous thrombolysis (alteplase or tenecteplase) vs. Door-to-needle time <60 minutes was evaluated on In-hospital all-cause mortality (OR 0.60, 95% CI 0.31-1.13, p=0.117). Intravenous thrombolysis reduced median NIHSS from 6 to 2 (p<0.001) with 10.7% in-hospital mortality, while door-to-needle time ≥60 min did not predict death (OR 0.60, 95% CI 0.31-1.13; p=0.117).

synapsesocial.com/papers/6ae5317cf47c78c6bae4b994 https://doi.org/10.5005/jp-journals-10071-25286

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Temporal Trends and Outcomes of Acute Ischemic Stroke Thrombolysis: More than a Decade of Experience from a Tertiary Care Stroke Center

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Temporal Trends and Outcomes of Acute Ischemic Stroke Thrombolysis: More than a Decade of Experience from a Tertiary Care Stroke Center

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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