Safety of a “Drip and Ship” Intravenous Thrombolysis Protocol for Patients with Acute Ischemic Stroke

Mansoor, Simin; Zand, Ramin; Al-Wafai, Ameer; Wahba, Mervat; Giraldo, Elias A.

doi:10.1016/j.jstrokecerebrovasdis.2011.12.010

Cited by 26 publications

(21 citation statements)

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“…Несмотря на широкое внедрение парадигмы «drip and ship» в систему оказания помощи при инсульте [6][7][8][9][10][11], в настоящее время имеются ограниченные данные 1(41) '2016 ЛЕЧЕНИЕ, РЕАБИЛИТАЦИЯ И ПРОФИЛАКТИКА о безопасности этого метода или характере оказания помощи после проведения системного тромболизиса в реальной клинической практике. Четкое распозна-вание и лечение неврологических и гемодинамических изменений в первые часы после ИИ являются клю-чевыми факторами для безопасности, в т.ч.…”

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“…во время транспортировки пациентов при использовании метода «drip and ship» [6]. Имеющиеся данные об исходах при использовании подхода «drip and ship», полученные при помощи клинически абстрагированных переменных, были ограничены одноцентровыми и региональными исследованиями, которые могли быть причиной систе-матической ошибки выборки и могли охарактеризовать только уровень оказания помощи в отдельных географи-ческих регионах [7][8][9]. Были опубликованы националь-ные данные, но в них не было клинических деталей [11].…”

Section: Sources Of Fundingunclassified

“…Crude in-hospital mortality (10.9%) and symptomatic intracranial hemorrhage (5.7%) in patients treated by the drip and ship method were slightly higher compared with those in front-door patients, and these differences persisted after risk adjustment. Although there is increasing adoption of the use of the drip and ship paradigm in stroke systems, [6][7][8][9][10][11] there are limited data on either the safety of this method or the nature of post-tPA care delivery in community-based practice. Prompt recognition and management of neurological and hemodynamic changes in the early hours after ischemic stroke are essential for safety, including during the medical transport period for patients treated by the drip and ship method.…”

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“…6 Available data using clinically abstracted variables on outcomes for drip and ship stroke have been limited to single-center and regional studies that may be subject to sampling bias and characteristics specific to individual regional networks. [7][8][9] National data have been published, but they are derived from claims data lacking clinical detail. 11 The generalizability of safety data, in particular, must be confirmed in patients treated in routine clinical practice because the drip and ship method becomes more commonly adopted.…”

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confidence: 99%

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Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke

Sheth

Smith

Grau‐Sepulveda

et al. 2015

Stroke

101

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Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke

Sheth

Smith

Grau‐Sepulveda

et al. 2015

Stroke

101

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“…Several reports have demonstrated the feasibility and safety of this AIS treatment approach and that it also increases regional tPA treatment rates among patients with AIS [12][13][14][15]. According to the DS paradigm, patients with an acute ischemic stroke begin receiving intravenous tPA at a community hospital and are then transferred to a regional CSC for further management of their condition, including post-thrombolysis neurointensive monitoring, endovascular treatment, and neurosurgical procedures.…”

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Drip, ship, and on-demand endovascular therapy for acute ischemic stroke

Park

Choi

et al. 2015

Journal of the Neurological Sciences

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Two Paradigms for Endovascular Thrombectomy After Intravenous Thrombolysis for Acute Ischemic Stroke

et al. 2017

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IMPORTANCE Intravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) is recommended to treat acute ischemic stroke (AIS) with a large vessel occlusion (LVO). Most hospitals do not have on-site MT facilities, and most patients need to be transferred secondarily after IVT (drip and ship), which may have an effect on the neurologic outcome.OBJECTIVE To compare the functional independence at 3 months between patients treated under the drip-and-ship paradigm and those treated on site (mothership). DESIGN, SETTING, AND PARTICIPANTSThis study used a prospectively gathered registry of patients with AIS to select patients admitted through the Saint-Antoine and Tenon (drip and ship) or the Fondation Rothschild (mothership) hospitals from January 1, 2013, through April 30, 2016. The study included patients older than 18 years treated with bridging therapy for AIS with LVO of the anterior circulation. Among the 159 patients who received MT at the mothership, 100 had been transferred after IVT from the drip-and-ship hospitals and 59 had received IVT on site. MAIN OUTCOMES AND MEASURESThe main outcome was 3-month functional independence (modified Rankin scale score Յ2). Both groups were compared using a multivariate linear model, including variables that were significantly different in the 2 groups.RESULTS During the study period, 497 patients were hospitalized at the drip-and-ship and mothership hospitals for an AIS eligible to reperfusion therapy; 11 patients had a basilar artery occlusion and were excluded, leaving 100 patients in the drip-and-ship group (mean age, 73 years; age range, 60-81 years; 57 men [57.0%]) and 59 in the mothership group (mean age, 70 years; age range, 58-82 years; 29 men [49.2%]). The proportion of patients with a favorable neurologic outcome at 3 months was similar in both groups (drip and ship, 61 [61.0%]; mothership, 30 [50.8%]; P = .26), even after adjusting the analysis for the baseline National Institutes of Health Stroke Scale score, diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score, and general anesthesia (P = .82). Patients had less severe conditions in the drip-and-ship group (median baseline National Institutes of Health Stroke Scale score, 15 vs 17 [P = .03]; median diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score, 7.5 vs 7 [P = .05]). Process times were longer in the drip-and-ship group (onset-to-needle time, 150 vs 135 minutes; onset-to-puncture time, 248 vs 189 minutes; and onset-to-recanalization time, 297 vs 240 minutes; P < .001). Both groups were similar in terms of substantial recanalization (Thrombolysis in Cerebral Ischemia scores 2B to 3; drip and ship, 84 [84.0%]; mothership, 47 [79.7%]; P = .49) and symptomatic hemorrhagic transformation (drip and ship, 2 [2.0%]; mothership, 2 [3.4%]; P = .63).CONCLUSIONS AND RELEVANCE This study found that patients treated under the drip-and-ship paradigm also benefit from bridging therapy, with no statistically significant difference compared with those treated ...

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Safety of a “Drip and Ship” Intravenous Thrombolysis Protocol for Patients with Acute Ischemic Stroke

Cited by 26 publications

References 6 publications

Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke

Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke

Drip, ship, and on-demand endovascular therapy for acute ischemic stroke

Two Paradigms for Endovascular Thrombectomy After Intravenous Thrombolysis for Acute Ischemic Stroke

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