Transfer After Fibrinolysis for Stroke | Journal Scan
What are the temporal trends and outcomes associated with drip and ship tissue-type plasminogen activator (tPA) use?
The authors analyzed data from 44,667 patients with ischemic stroke treated with intravenous tPA ≤3 hours of symptom onset in the Get With The Guidelines-Stroke program from April 2003 to October 2010, in 1,440 hospitals. The main outcomes were the frequency of drip and ship tPA use over time and the associated in-hospital outcomes, treatments, and complications in these patients.
Of the 44,667 patients treated with tPA, the drip and ship method was used in 10,475 (23.5%). There was an increase in use of this approach that paralleled the uptake in the traditional tPA method. Patients treated by the drip and ship method had lower National Institutes of Health Stroke Scale (NIHSS) scores (11 vs. 12, p < 0.0001), and the percentage of patients with NIHSS score 0-4 was higher (14.7% vs. 9.1%; p < 0.0001). Crude in-hospital mortality (10.9% vs. 9.6%) and symptomatic intracranial hemorrhage (5.7% vs. 5.22%) were slightly higher in patients treated by the drip and ship method compared with those in front-door patients, and these differences persisted after risk adjustment.
Drip and ship tPA is used in one in four patients treated with tPA in the United States. These patients have a slightly increased rate of mortality and symptomatic intracranial hemorrhage compared with those in front-door patients.
This study suggests that the drip and ship strategy is being widely applied in the United States, and is associated with good outcomes. The results of the ESCAPE trial (Goyal M, et al., N Engl J Med 2015) suggest that the next step in this paradigm would be rapid transfer for endovascular reperfusion with the possible goal of further reducing mortality and morbidity.
Keywords: Hospital Mortality, Stroke, Intracranial Hemorrhages, Tissue Plasminogen Activator, Plasminogen Activators, Risk Adjustment
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