Dosing Tissue Plasminogen Activator on a Mobile Stroke Unit: Comparison Between Estimated and Hospital-Measured Weights

2021 ◽  
Vol 53 (4) ◽  
pp. E4-E4
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen

Abstract WP72: Early Experience on Intravenous Tissue Plasminogen Activator Delivery in Mobile Stroke Unit Patients with Stroke Mimics

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lila E Sheikhi ◽  
Stacey Winners ◽  
Pravin George ◽  
Andrew Russman ◽  
Zeshaun Khawaja ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Early Experience ◽  
Final Diagnosis ◽  
Stroke Mimics ◽  
Intravenous Tissue Plasminogen Activator ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background: A mobile stroke unit (MSU) allows for early delivery for intravenous tissue plasminogen activator (IV-tPA). A proportion of IV-tPA treated patients may turn out to be stroke mimics. We evaluated the rate and complications seen in stroke mimics treated with tPA from our early experience on MSU. Methods: Retrospective review of patients treated with IV-tPA on the MSU from 2014 to 2016. Charts were reviewed for confirmed strokes by imaging (MRI or CT) and hemorrhagic transformation. Stroke mimics were defined as those without imaging evidence of infarction and a final diagnosis which was not suspected to be stroke. Results: Among 62 patients treated with IV-tPA, 14 (28.6%) had a final diagnosis consistent with a stroke mimics. The majority of these occurred in the first year of the MSU program. Most common mimics included conversion disorder (n=5) and seizures (n=5). While the last known well to IV-tPA times were similar, the MSU door-to-needle time was significantly longer in stroke mimics (38 vs 31 minutes, p = 0.03). No intracerebral hemorrhages or other IV-tPA related complications were identified in the stroke mimics group. Conclusions: In our early experience with MSU, treatment of stroke mimics occurred without IV-tPA related complications. This does not appear to be due to rushed decision making.

scholarly journals Benefits of stroke treatment delivered using a mobile stroke unit trial

2017 ◽  
Vol 13 (3) ◽  
pp. 321-327 ◽  
Author(s):  
Jose-Miguel Yamal ◽  
Suja S Rajan ◽  
Stephanie A Parker ◽  
Asha P Jacob ◽  
Michael O Gonzalez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Healthcare Utilization ◽  
Stroke Unit ◽  
Standard Management ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen

Rationale Mobile stroke units speed treatment for acute ischemic stroke, thereby possibly improving outcomes. Aim To compare mobile stroke unit and standard management clinical outcomes, healthcare utilization, and cost-effectiveness in tissue plasminogen activator-eligible acute ischemic stroke patients calling 911. Sample size 693. Eighty percent power with 0.05 type I error rate to detect a difference of 0.09 in mean utility-weighted modified Rankin scale between groups. Design Phase III, multicenter, prospective cluster-randomized (mobile stroke unit versus standard management weeks) comparative effectiveness study in tissue plasminogen activator-eligible patients. Outcomes Primary: Ninety-day mean utility-weighted modified Rankin scale. Coprimary: cost-effectiveness based on EQ5D quality of life and one year poststroke costs. Analysis Two-sample t-test and linear regression adjusting for covariates; incremental cost-effectiveness ratio and net benefit regression. Results As of March 2017, 288 tissue plasminogen activator-eligible patients have been enrolled (173 in the mobile stroke unit arm and 115 in the standard management arm). Two new centers start in early 2017 with target end of recruitment September 2019. Conclusion This is the first randomized study to test for disability, healthcare utilization, and cost-effectiveness of a mobile stroke unit. The progress of the study suggests that it is feasible. Management of tissue plasminogen activator eligible acute ischemic stroke patients by a mobile stroke unit could potentially result in less disability and healthcare utilization, and be cost effective. Mobile stroke units are very costly. This trial may determine if the fixed cost can be justified by a reduction in disability and healthcare utilization. Clinical Trial Registration NCT02190500.

Intraosseous Administration of Tissue Plasminogen Activator on a Mobile Stroke Unit

2018 ◽  
Vol 23 (4) ◽  
pp. 447-452 ◽  
Author(s):  
Ritvij Bowry ◽  
May Nour ◽  
Teresa Kus ◽  
Stephanie Parker ◽  
Jonathan Stephenson ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen

scholarly journals Dosing Tissue Plasminogen Activator on a Mobile Stroke Unit

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Asha P. Jacob ◽  
Mengxi Wang ◽  
Munachi Okpala ◽  
Jose-Miguel Yamal ◽  
James C. Grotta ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen

Abstract 158: Time to Decision and Treatment With Tissue Plasminogen Activator Using Telemedicine versus an On-board Physician on a Mobile Stroke Unit

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Ritvij Bowry ◽  
Stephanie Parker ◽  
Jose-Miguel Yamal ◽  
Savitri Appana ◽  
Nicole Rangel-Gutierrez ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen

Detection and Primary Care Management of Acute Stroke

2012 ◽  
Vol 5 (6) ◽  
pp. 325-331
Author(s):  
Sudharani Manapragada ◽  
Peter Wanklyn ◽  
Sean McDermott
Keyword(s):  
Primary Care ◽  
Acute Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Care Management ◽  
Stroke Treatment ◽  
Hyperacute Stroke ◽  
Tissue Plasminogen ◽  
Primary Care Management

‘Time is brain’ is the basis of modern day hyperacute stroke treatment. It is important to recognize an acute stroke and arrange immediate admission to a hyperacute stroke unit (HASU) to facilitate investigation, stabilization and emergency therapy, such as thrombolysis with tissue plasminogen activator (t-PA).

Target Door-to-Needle Time for Tissue Plasminogen Activator Treatment with Magnetic Resonance Imaging Screening Can Be Reduced to 45 min

2018 ◽  
Vol 45 (5-6) ◽  
pp. 245-251 ◽  
Author(s):  
Denis Sablot ◽  
Ioana Ion ◽  
Khaled Khlifa ◽  
Geoffroy Farouil ◽  
Franck Leibinger ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Screening Tool ◽  
Resonance Imaging ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Baseline Characteristics ◽  
Magnetic Resonance Imaging Screening ◽  
Stroke Centre

Objective: The purpose of this study was to demonstrate that the median door-to-needle (DTN) time for intravenous tissue plasminogen activator (tPA) treatment can be reduced to 45 min in a primary stroke centre with MRI-based screening for acute ischaemic stroke (AIS). Methods: From February 2015 to February 2017, the stroke unit of Perpignan general hospital, France, implemented a quality-improvement (QI) process. During this period, patients who received tPA within 4.5 h after AIS onset were included in the QI cohort. Their clinical characteristics and timing metrics were compared each semester and also with those of 135 consecutive patients with AIS treated by tPA during the 1-year pre-QI period (pre-QI cohort). Results: In the QI cohort, 274 patients (92.5%) underwent MRI screening. While the demographic and baseline characteristics were not significantly different between cohorts, the median DTN time was significantly lower in the QI than in the pre-QI cohort (52 vs. 84 min; p < 0.00001). Within the QI cohort, the median DTN time for each semester decreased from 65 to 44 min (p < 0.00001) and the proportion of treated patients with a DTN time ≤45 min increased from 25 to 58.9% (p < 0.0001). Overall, DTN time improvement was associated with a better outcome at 3 months (patients with a modified Rankin Scale score between 0 and 2: 61.8% in the QI vs. 39.3% in the pre-QI cohort; p < 0.0001). Conclusions: A QI process can reduce the DTN within 45 min with MRI as a screening tool.

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