# Beating the clock: comparing the speed of anticoagulation reversal in intracerebral haemorrhage to thrombolysis for acute ischaemic stroke

## TL;DR

This study compares how quickly emergency treatments are given for two types of stroke and finds that one is significantly slower than the other.

## Contribution

The study provides a nationwide comparison of treatment speed for intracerebral hemorrhage and acute ischemic stroke.

## Key findings

- Door-to-needle time was 49 minutes for ICH patients versus 28 minutes for AIS patients.
- ICH patients had longer onset-to-door times and higher NIHSS scores compared to AIS patients.
- The study highlights the need for improved emergency workflows for ICH treatment.

## Abstract

Intravenous thrombolysis (IVT) for acute ischaemic stroke (AIS) and anticoagulation reversal for intracerebral haemorrhage (ICH) are both emergency stroke treatments. We hypothesized that, given the similar logistics, door-to-needle times should be comparable for both treatments.

We used data from 2023 and 2024 from the Dutch Acute Stroke Audit, a national stroke registry with 66 contributing hospitals in the Netherlands. We compared door-to-needle time of patients with anticoagulation-related ICH who received a reversal agent to patients with AIS who received IVT.

Of 1,897 adult patients with anticoagulation related ICH, 1018 (54%) received a reversal agent, of whom 579 (57%) had available door-to-needle times. Of 67,699 AIS patients, 14,192 (21%) received IVT and 13,752 (97%) had available door-to-needle times. ICH patients were older (80 years vs 74 years, P < .001) and had a higher NIHSS at presentation (7 vs 4, P < .001) compared to AIS patients. Onset-to-door times were longer for ICH patients than AIS patients (78 min vs 73 min, P < .001). Median door-to-needle time was 49 (IQR: 30–90) min for ICH patients and 28 (IQR: 20–41) min for AIS patients (adjusted β = −0.573; 95% CI, −0.631 to −0.515; P < .001).

In this nationwide study, door-to-needle time was substantially longer for anticoagulation reversal in ICH patients than IVT in AIS patients. This indicates that there is room for improvement in the emergency workflow of ICH patients.

Graphical Abstract