Hospital-based intervention to reduce tPA administration time

Dhaliwal, Joravar; Ferrigno, Bryan; Abiola, Olumide Bashiru; Moskalik, Anzhela D.; Sposito, Jennifer; Wolansky, Leo; Mui, Gracia; Bulsara, Ketan R.; Mittal, Sanjay

doi:10.1016/j.inat.2018.09.005

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…In the present study, the Mean±SD time to refer to the emergency room until receiving a physical examination by the neurologist was measured as 423.62 406.147 minutes, i.e., much higher than that obtained by Hatamabadi et al (100±211 min) [12]. A study reported that tPA injection at the imaging center immediately after performing CT scan decreased 26 minutes from the time of the main protocol (when the patient returns to the emergency room, then was injected) [22].…”

Section: Discussionmentioning

confidence: 82%

Barriers to Receiving Tissue Plasminogen Activator in Patients with Ischemic Stroke

Mirzadeh

Mozhdehipanah

Emami

et al. 2021

JQUMS

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Background: Cerebrovascular diseases are the second common cause of mortality worldwide. The onset of reperfusion in the first 3-4.5 hours is a predictive factor of treatment. Objective: The present study investigated barriers to receiving tissue plasminogen activator in patients with ischemic stroke. Methods: This cross-sectional study examined 191 patients with first-ever stroke referring to the emergency department of the Persian Gulf Martyrs Hospital of Bushehr City, Iran, in 2016. One checklist was completed which included demographic data, history of diseases, knowledge of stroke symptoms, and intervals regarding the onset of symptoms to informing emergency, informing emergency on arrival at the emergency department of the hospital, and making the diagnosis for the patients. The obtained data were analyzed in SPSS v. 19. Results: Mean±SD age of the patients was 65.92±12.48 years. The majority of patients under investigation (55.5%) were female, 63.4% were married, 56% were illiterate and 72.3% resided in other districts of Bushehr province. Mean duration between onset of symptoms and arrival at emergency department, onset of symptoms and call the emergency service, time of arrival at emergency department to perform brain Computer Tomography (CT) scan and also to be counseled by a neurologist were 699.66, 195.51, 45.11 and 423.62 minutes, respectively. Finally 14.6 percent of patients were qualified to be treated with tPA. Conclusion: The main barrier to timely therapy is a delay in golden time. Therefore, public education to promote public awareness could be of great benefit in reducing the referral delay time.

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Section: Discussionmentioning

confidence: 82%

Barriers to Receiving Tissue Plasminogen Activator in Patients with Ischemic Stroke

Mirzadeh

Mozhdehipanah

Emami

et al. 2021

JQUMS

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“…In the study of Ayromlou et al in Tabriz, Iran, the mean time of patients' arrival to the hospital and CT scan was 91 minutes, which was 66 minutes longer than the international guidelines, and the mean time of patients' arrival to the hospital and receiving rTPA was 147 minutes, 87 minutes longer compared to the international guidelines (20). In the Dhaliwal et al study in the United States, the mean initial CT scan time was 13.66 minutes, the CT scan interpretation time was 25.20 minutes, and the time between the patient's arrival and rTPA injection was 51.27 minutes (36). In the study of Hasankhani et al in Tabriz,…”

Section: Discussionmentioning

confidence: 89%

Factors affecting pre-hospital and in-hospital delays at time-to-treatment and complications in stroke: A prospective cohort study

Ghadimi¹,

Hanifi²,

Dinmohammadi³

2020

Preprint

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Background: Time-to-treatment affects the outcomes of acute ischemic stroke (AIS). The aim of this study was to determine the factors affecting pre-hospital and in-hospital delays in the time-to-treatment and complication in AIS. Methods: This prospective study was performed on 204 AIS patients referred to the stroke care unit in Iran (Zanjan) in 2019. Data were completed by interviewing the patients, their families, records, and observations. The mortality and complication rates were recorded for 30 post-stroke days through call follow-up. Results: The results showed that the highest delay was related to the onset-to-arrival time (288.19 ±339.02 minutes). Results of logistic regression showed that treatment delay declined significantly by consulting followed by symptoms onset, patient transfer through emergency medical service to the hospital, and patients’ understanding of AIS symptoms. The results also showed that increasing the onset-to-treatment time (P< .001) and high National Institutes of Health Stroke Scale (NIHSS) score (P< .000) were the most important factors associated with post-stroke complications. High age (P< .044) and high NIHSS scores (P< .001) were significantly associated with mortality in patients with AIS. Conclusion: Informing people about AIS symptoms and referring to AIS treatment units are essential in reducing the treatment time.

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“…The efficacy of both EVT and medical thrombolysis with alteplase is highly time-dependent, and difficulties in determining intravenous alteplase eligibility and initial transfer to a primary stroke center for its administration can substantially delay EVT, thereby reducing EVT efficacy and ultimately worsening patient outcome. [13][14][15][16] Moreover, the absolute rate of major hemorrhage is slightly higher when alteplase is used, though it is not statistically significant. 17,18 Both EVT and intravenous alteplase may cause thrombus fragmentation and distal embolization, but when alteplase is used primarily, it may convert a relatively straightforward M1 embolectomy into a more difficult procedure, involving $2 middle cerebral artery branch occlusions.…”

Section: Discussionmentioning

confidence: 91%

How Do Physicians Approach Intravenous Alteplase Treatment in Patients with Acute Ischemic Stroke Who Are Eligible for Intravenous Alteplase and Endovascular Therapy? Insights from UNMASK-EVT

Ospel¹,

Kashani²,

Fischer³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: With increasing use of endovascular therapy, physicians' attitudes toward intravenous alteplase in endovascular therapy-eligible patients may be changing. We explored current intravenous alteplase treatment practices of physicians in endovascular therapy-and alteplase-eligible patients with acute stroke using prespecified case scenarios and compared how their current local treatment practices differ compared with an assumed ideal environment. MATERIALS AND METHODS: In an international multidisciplinary survey, 607 physicians involved in acute stroke care were randomly assigned 10 of 22 case scenarios, among them 14 with guideline-based alteplase recommendations (9 with level 1A and 5 with level 2B recommendation) and were asked how they would treat the patient: A) under their current local resources, and B) under assumed ideal conditions. Answer options were the following: 1) anticoagulation/antiplatelet therapy, 2) endovascular therapy, 3) endovascular therapy plus intravenous alteplase, and 4) intravenous alteplase. Decision rates were calculated, and multivariable regression analysis was performed to determine variables associated with the decision to abandon intravenous alteplase. RESULTS: In cases with guideline recommendations for alteplase, physicians favored alteplase in 82.0% under current local resources and in 79.3% under assumed ideal conditions (P , .001). Under assumed ideal conditions, interventional neuroradiologists would refrain from intravenous alteplase most often (6.28%, OR 4 2.40; 95% CI, 1.01-5.71). When physicians' current and ideal decisions differed, most would like to add endovascular therapy to intravenous alteplase in an ideal setting (196/3861 responses, 5.1%). CONCLUSIONS: In patients eligible for endovascular therapy and intravenous alteplase, we observed a slightly lower decision rate in favor of intravenous alteplase under assumed ideal conditions compared with the decision rate under current local resources.

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Hospital-based intervention to reduce tPA administration time

Cited by 9 publications

References 20 publications

Barriers to Receiving Tissue Plasminogen Activator in Patients with Ischemic Stroke

Barriers to Receiving Tissue Plasminogen Activator in Patients with Ischemic Stroke

Factors affecting pre-hospital and in-hospital delays at time-to-treatment and complications in stroke: A prospective cohort study

How Do Physicians Approach Intravenous Alteplase Treatment in Patients with Acute Ischemic Stroke Who Are Eligible for Intravenous Alteplase and Endovascular Therapy? Insights from UNMASK-EVT

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