title: Is the drip-and-ship approach to delivering thrombolysis for acute ischemic stroke safe?
abstract: 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.
authors.affiliation: Department of Neurology, University of Texas-Houston Health Science Center, Houston, Texas, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
authors.forename: Miriam M
authors.initials: MM
authors.lastname: Morales
authors.forename: Aslam M
authors.initials: AM
authors.lastname: Khaja
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Barreto
authors.forename: Hen
authors.initials: H
authors.lastname: Hallevi
authors.forename: Anitha
authors.initials: A
authors.lastname: Abraham
authors.forename: M Rick
authors.initials: MR
authors.lastname: Sline
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jones
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.forename: Sean I
authors.initials: SI
authors.lastname: Savitz
mesh_terms: 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
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator