NASHVILLE — Nearly one in four ischemic stroke patients are being treated with the drip and ship method of intravenous tissue plasminogen activator, suggesting to researchers that it is an important strategy for delivering the benefits of intravenous tissue plasminogen activator (IV tPA) to patients.
Results of the study, which was the largest of its kind to date, were presented at the International Stroke Conference 2015.
“Since time is brain, getting to the place where you can get tPA the fastest is the most important thing. However, a hospital may not be set up to provide all the follow-up care and to deal with complications,” study researcher Kevin N. Sheth, MD, of Yale University in New Haven, Conn., said in an interview with Neurology Advisor. “One of the strategies that has emerged is the drip and slip method where tPA is administered at one hospital followed by a transfer typically to a larger hospital, stroke center or academic center, so that the patients can receive the rest of the care at that referring institution.”
Sheth and colleagues enrolled 44,667 ischemic stroke patients (median age 72 years; 49% women) from 1,440 Get With The Guidelines-Stroke hospitals between 2003 and 2010. Patients were treated with tPA less than 3 hours from symptom onset.
Researchers reported that the drip and ship method was used in 23.5% of patients. The rate of those who were tPA eligible and treated with drip and ship rose steadily during the study period (4% to 7.6%; P<.0001).
“While tPA use has increased over time, it has been somewhat proportional to the increase in drip and ship use over a similar time period, implying that perhaps the drip and ship strategy has facilitated even more widespread tPA use,” Sheth said.
Overall, drip-and-ship patients when compared with front-door patients were younger and more often male and white. They were also more likely to arrive during off hours, defined as times other than Monday through Friday from 7 a.m. to 5 p.m. (71% vs. 53%; P<.0001).
Researchers reported that hospitals of drip and ship patients had more beds (488 vs. 385; P<.0001), and were more likely to be an academic medical center (81% vs. 61%; P<.0001), have a higher volume of annual ischemic stroke cases (273 vs. 206; P<.0001) and have Joint Commission Primary Stroke Center Certification (70% vs. 63%; P<.0001).
In addition, the Midwest was the most common location for drip and ship hospitals.
For more coverage of the International Stroke Conference 2015, go here.
- Sheth KN et al. Abstract 85. Presented at: International Stroke Conference 2015; Feb. 11-13, 2015; Nashville, Tennessee.