Drip-and-ship thrombolytic treatment paradigm among acute ischemic stroke patients in the United States.
OBJECTIVE
To provide a national assessment of thrombolytic administration using drip-and-ship treatment paradigm.


METHODS
Patients treated with the drip-and-ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment were identified within the Nationwide Inpatient Sample. Thrombolytic utilization, patterns of referral, comparative in-hospital outcomes, and hospitalization charges related to drip-and-ship paradigm were determined. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis.


RESULTS
Of the 22 243 ischemic stroke patients who received thrombolytic treatment, 4474 patients (17%) were treated using drip-and-ship paradigm. Of these 4474 patients, 81% were referred to urban teaching hospitals for additional care, and 7% of them received follow-up endovascular treatment. States with a higher proportion of patients treated using the drip-and-ship paradigm had higher rates of overall thrombolytic utilization (5.4% versus 3.3%; P<0.001). The rate of home discharge/self-care was significantly higher in patients treated with drip-and-ship paradigm compared with those who received thrombolytics through primary emergency department arrival in the multivariate analysis (OR, 1.198; 95% CI, 1.019-1.409; P=0.0286).


CONCLUSIONS
One of every 6 thrombolytic-treated patients in United States is treated using drip-and-ship paradigm. States with the highest proportion of drip-and-ship cases were also the states with the highest thrombolytic utilization.
Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 420 Delaware Street SE, MMC 295, Minneapolis, MN 55455, USA. tekl0027@umn.edu
Wondwossen G
WG
Tekle
Saqib A
SA
Chaudhry
Ameer E
AE
Hassan
Gustavo J
GJ
Rodriguez
M Fareed K
MF
Suri
Adnan I
AI
Qureshi
D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous / Q000639:trends; D008297:Male; D012648:Self Care / Q000639:trends; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology