Is the drip-and-ship approach to delivering thrombolysis for acute ischemic stroke safe?
BACKGROUND
The drip-and-ship method of treating stroke patients may increase the use of tissue plasminogen activator (t-PA) in community hospitals.


OBJECTIVE
The safety and early outcomes of patients treated with t-PA for acute ischemic stroke (AIS) by the drip-and-ship method were compared to patients directly treated at a stroke center.


METHODS
The charts of all patients who were treated with intravenous (i.v.) t-PA at outside hospitals under the remote guidance of our stroke team and were then transferred to our facility were reviewed. Baseline NIHSS (National Institutes of Health Stroke Scale) scores, onset-to-treatment (OTT), and arrival-to-treatment (ATT) times were abstracted. The rates of in-hospital mortality, symptomatic hemorrhage (sICH), early excellent outcome (modified Rankin Scale [mRS] ≤ 1), and early good outcome (discharge home or to inpatient rehabilitation) were determined.


RESULTS
One hundred sixteen patients met inclusion criteria. Eighty-four (72.4%) were treated within 3 h of symptom onset. The median estimated NIHSS score was 9.5 (range 3-27). The median OTT time was 150 min, and the median ATT was 85 min. These patients had an in-hospital mortality rate of 10.7% and sICH rate of 6%. Thirty percent of patients had an early excellent outcome and 75% were discharged to home or inpatient rehabilitation. When these outcome rates were compared with those observed in patients treated directly at our stroke center, there were no statistical differences.


CONCLUSIONS
In this small retrospective study, drip-and-ship management of delivering i.v. t-PA for AIS patients did not seem to compromise safety. However, a large prospective study comparing drip-and-ship management to routine care is needed to validate the safety of this approach to treatment.
Martin-Schild
Sheryl
S
Department of Neurology, University of Texas-Houston Health Science Center, Houston, Texas, USA.
Morales
Miriam M
MM
Khaja
Aslam M
AM
Barreto
Andrew D
AD
Hallevi
Hen
H
Abraham
Anitha
A
Sline
M Rick
MR
Jones
Elizabeth
E
Grotta
James C
JC
Savitz
Sean I
SI
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality; D002985:Clinical Protocols; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use; D014187:Transportation of Patients; D014481:United States / Q000453:epidemiology
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator