The 45-Minute Mark: Factors Driving Ultra-rapid Thrombolysis in a Dominican Republic Stroke Center
Sabrina Lora1, María Cedeño-Bruzual1, Chanel Reyes1, Marian Javier1, Francisco Méndez2, Edwina Luna Rodríguez3, Stephanie Castro Turbi3
1Knowledge Management and Epidemiology Department, 2Emergency Department, 3Neurology Department, Centers for Diagnostic and Advanced Medicine and Medical Conferences and Telemedicine (CEDIMAT)
Objective:
To evaluate clinical and logistical factors linked to door-to-needle time (DTN) <45 minutes in a Dominican Republic tertiary center.
Background:
Intravenous thrombolysis (IVT) improves outcomes in acute ischemic stroke (AIS); however, each minute of delay lessens the potential for neurological recovery. Achieving rapid treatment is therefore critical—patients treated within 45 minutes of arrival have significantly lower mortality, reduced disability, and fewer readmissions.
Design/Methods:
Retrospective, cross-sectional study of AIS patients receiving IVT between October 2022 and July 2025 (n=60). Sociodemographic, clinical, and operational variables were extracted from medical records. Descriptive and comparative analyses assessed predictors of DTN <45 vs ≥45 minutes, and a rapid IVT prediction model was generated using STATA 19.0.
Results:
Median age was 73.5 years (IQR 29.5), with 60% male. Median onset-to-door time (OTD) was 141.5 minutes (IRQ 80.5), door-to-imaging time (DTI) 25 minutes, and DTN 52 minutes; 48.3% achieved DTN <45 minutes. Emergency medical service (EMS) was the most frequent arrival mode in both groups. Each NIHSS point increased the odds of DTN <45 minutes by 68.9% (p=0.022), each OTD minute by 2.5% (p=0.005), and each year of age by 15% (p=0.003). In contrast, EMS arrival, and prior stroke reduced the odds of DTN <45 minutes by 98.2% (p=0.036) and 98.6% (p=0.041), respectively. Higher systolic blood pressure also lowered the odds by 9.9% per mmHg (p=0.02).
Conclusions:
Higher NIHSS, older age, and longer OTD were associated with faster IVT, whereas EMS arrival, prior stroke, and elevated systolic blood pressure predicted DTN >45 minutes. These findings highlight the need to strengthen both prehospital and in-hospital processes, especially for patients with identifiable risk factors, to ensure timely and equitable acute stroke care.
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