Improving Door-to-Needle Times for Acute Ischemic Stroke

Faster treatment with intravenous alteplase (tissue-type plasminogen activator) results in better outcomes. Although the benchmark door-to-needle time (DTN) has been set at 60 minutes, many centers have been able to exceed this benchmark with median times from 20 to 51 minutes. These local efforts have been supported by national and international efforts to reduce DTN time. For example, the American Heart Association’s Target: Stroke initiative, which promoted 10 specific strategies to reduce DTN time, was associated with improvements in DTN time such that more than half of the patients were treated within the benchmark of 60 minutes. Similarly, Europe and other countries have made significant strides toward improving DTN time with the SITS (Safe Implementation of Treatment in Stroke) Watch project. See Editorial by Prabhakaran and Mendelson