‘Drip and ship’ thrombolytic therapy for acute ischemic stroke common in US

NASHVILLE, Tenn. — Approximately 1 in 4 patients with acute ischemic stroke who receives IV tissue plasminogen activator is then transferred to a certified stroke center. These transfers have become more common with time, according to data presented at the International Stroke Conference.

Researchers investigated national trends in interhospital transfer after use of tissue plasminogen activator (tPA), a practice known as “drip and ship.” This method aims to increase tPA use and timely administration, according to Kevin N. Sheth, MD, and colleagues.

Kevin N. Sheth

The researchers analyzed data from 44,667 patients (median age, 72 years; 49% women; 12% black; 5% Hispanic) treated with IV tPA 3 hours or less after symptom onset in 1,440 U.S. hospitals participating in the American Heart Association’s Get with the Guidelines–Stroke program from 2003 to 2010.

The primary outcome was frequency of drip and ship tPA use with time. The researchers also analyzed various patient and hospital-level characteristics.

Among those who received tPA, drip and ship occurred 23.5% of the time during the study period.

Among all tPA-eligible patients, the percentage treated via drip and ship increased from 4% in 2003 to 7.6% in 2010 (P < .0001), according to the researchers.

Compared with those who were not transferred, patients treated via drip and ship were younger, more likely to be men and more likely to be white, Sheth and colleagues found.

“One in four is a very good number, and while we don’t know the best target, there may be room for improvement,” Sheth, chief of the neurocritical care and emergency neurology division at Yale University School of Medicine, said in a press release. “We have to understand geographic and community variation in usage of interhospital transfer of tPA patients, and why some communities may use it more than other communities. Ultimately, the goal is to have any patient that presents to their initial hospital anywhere in the country be able to receive tPA.”

Patients treated via drip and ship were more likely to arrive during off-hours, defined as outside of 7 a.m. to 5 p.m. Monday through Friday, compared with those not transferred (71% vs. 53%; P < .0001), according to other results presented.

Hospitals that received patients via the drip and ship process were larger (488 beds vs. 385 beds; P < .0001), more likely to be an academic medical center (81% vs. 61%; P < .0001), had a higher annual volume of patients with ischemic stroke (273 vs. 206; P < .0001) and more likely to have primary stroke center certification (70% vs. 63%; P < .0001), according to the researchers. In addition, among U.S. regions, the Midwest had the highest proportion of hospitals receiving patients via drip and ship. – by Erik Swain

References:

Sheth KN, et al. Abstract 85. Presented at: International Stroke Conference; Feb. 11-13, 2015; Nashville, Tenn.

Sheth KN, et al. Stroke. 2015;doi:10.1161/STROKEAHA.114.007506.

Disclosure: Sheth reports no relevant financial disclosures.