Identification of Rate-Limiting Steps in the Provision of Thrombolytics for Acute Ischemic Stroke.
BACKGROUND
Tissue plasminogen activator (tPA) is the only pharmacotherapy shown to improve outcomes in acute ischemic stroke. The American Heart Association (AHA) recommends a door-to-needle (DTN) time of <60 minutes in at least 50% of patients presenting with acute ischemic stroke.


OBJECTIVE
The purpose of this study was to analyze the possible barriers that may delay tPA administration within the emergency department (ED) of an academic medical center.


METHODS
A retrospective chart review was conducted from February 2011 to October 2013. Patients were included if they were admitted through the ED with a diagnosis of acute ischemic stroke and received tPA.


RESULTS
Of the 130 patients who met inclusion criteria, 43.1% received tPA in ≤60 minutes. Several factors were identified to be significantly different in those with a DTN time of >60 minutes-time to ED physician consultation, neurologist arrival, blood sample acquisition, and result time ( P < .05 for all comparisons). Correlation analysis demonstrated several independent variables associated with DTN time of ≤60 minutes-time from admission to ED physician consultation, receipt of computed tomography (CT) scan, blood sample acquisition, laboratory results, and neurology service arrival ( P < .05 for all comparisons).


CONCLUSIONS
The findings from this study highlight the importance of prompt physician evaluation, direct transfer to the CT scanner, and a quick turnaround time on laboratory values. The development of protocols to ensure the rapid receipt of tPA therapy should focus on limiting any potential delay these steps may cause.
1 Pharmacy Department, St Rose Dominican Hospitals, Henderson, NV, USA.
Elise L
EL
Metts
2 Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA.
Abby M
AM
Bailey
3 Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
Kyle A
KA
Weant
4 Clinical Pharmacy Services, St Claire Regional Medical Center, Morehead, KY, USA.
Stephanie B
SB
Justice
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods* / Q000592:standards; D061665:Time-to-Treatment / Q000592:standards; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
alteplase; barriers; ischemic stroke; tPA; thrombolytics