Abstract
Background: The drip-and-ship method of treating stroke patients may increase the
use of tissue plasminogen activator (t-PA) in community hospitals. Objective: The
safety and early outcomes of patients treated with t-PA for acute ischemic stroke
(AIS) by the drip-and-ship method were compared to patients directly treated at a
stroke center. Methods: The charts of all patients who were treated with intravenous
(i.v.) t-PA at outside hospitals under the remote guidance of our stroke team and
were then transferred to our facility were reviewed. Baseline NIHSS (National Institutes
of Health Stroke Scale) scores, onset-to-treatment (OTT), and arrival-to-treatment
(ATT) times were abstracted. The rates of in-hospital mortality, symptomatic hemorrhage
(sICH), early excellent outcome (modified Rankin Scale [mRS] ≤ 1), and early good
outcome (discharge home or to inpatient rehabilitation) were determined. Results:
One hundred sixteen patients met inclusion criteria. Eighty-four (72.4%) were treated
within 3 h of symptom onset. The median estimated NIHSS score was 9.5 (range 3–27).
The median OTT time was 150 min, and the median ATT was 85 min. These patients had
an in-hospital mortality rate of 10.7% and sICH rate of 6%. Thirty percent of patients
had an early excellent outcome and 75% were discharged to home or inpatient rehabilitation.
When these outcome rates were compared with those observed in patients treated directly
at our stroke center, there were no statistical differences. Conclusions: In this
small retrospective study, drip-and-ship management of delivering i.v. t-PA for AIS
patients did not seem to compromise safety. However, a large prospective study comparing
drip-and-ship management to routine care is needed to validate the safety of this
approach to treatment.
Keywords
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Article info
Publication history
Published online: March 09, 2009
Accepted:
October 12,
2008
Received in revised form:
September 5,
2008
Received:
April 21,
2008
Footnotes
Drs. Martin-Schild, Barreto, and Abraham are supported by training grant 5-T32-NS007412-09 from the National Institutes of Health to the University of Texas–Houston Medical School Stroke Program.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
