ABSTRACT NUMBER: ESOC2026A1757 FASTER IS BETTER EFFECT OF EMERGENCY DEPARTMENT INITIATED INTRAVENOUS THROMBOLYSIS ON DOOR TO NEEDLE TIME AND CLINICAL OUTCOMES IN A MOLDOVAN STROKE CENTER

Abstract Background and aims Timely administration of intravenous thrombolysis (IVT) is a determinant of outcome in acute ischemic stroke. Although a door-to-needle time (DNT) of <45 minutes is recommended, this target is difficult to achieve, particularly in resource-limited healthcare systems. In 2025, our center implemented direct initiation of IVT bolus administration in the emergency department (ED). We aimed to evaluate the impact of this organizational change on DNT and neurological and functional outcomes. Methods We conducted a retrospective observational study including all patients with acute ischemic stroke treated with IVT between 2019 and 2025 in a tertiary stroke center. Patients treated before 2025 were compared with those treated after ED-initiated thrombolysis implementation. DNT, stroke severity assessed by the National Institutes of Health Stroke Scale (NIHSS), functional outcome at discharge assessed by the modified Rankin Scale (mRS), and hemorrhagic transformation were analyzed. Results A total of 400 patients were included; 62% were treated before 2025 and 38% after ED-initiated thrombolysis. Following implementation, mean DNT was reduced from 76 to 44 minutes. Patients treated after 2025 presented with lower baseline NIHSS scores and demonstrated greater neurological recovery. Functional outcomes at discharge improved, with median mRS decreasing from 4 to 2. Hemorrhagic transformation rates decreased from 31% to 15%, without an increase in clinical deterioration. Conclusions Initiation of intravenous thrombolysis directly in the emergency department was associated with a reduction in DNT and enhanced neurological and functional outcomes. These findings underscore the value of pragmatic organizational optimization in acute stroke care delivery, particularly in healthcare systems with limited resources. Conflict of interest Levca Anastasia.nothing to disclose