Thrombolytic Treatment Using Drip and Ship Treatment Paradigm among Acute Ischemic Stroke Patients in the United States: Outcomes and Impact on Regional Thrombolytic Utilization and Referral Patterns (S03.002)

Neurology ◽  
2012 ◽  
Vol 78 (Meeting Abstracts 1) ◽  
pp. S03.002-S03.002
Author(s):  
G. Rodriguez ◽  
W. Tekle ◽  
S. Chaudhry ◽  
A. Hassan ◽  
M. Suri ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Referral Patterns ◽  
Treatment Paradigm

Abstract 196: Thrombolytic Treatment using Drip and Ship Treatment Paradigm among Acute Ischemic Stroke Patients in the United States: Outcomes and impact on regional thrombolytic utilization and referral patterns

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Wondwossen G Tekle ◽  
Saqib A Chaudhry ◽  
Habib Qaiser ◽  
Ameer E Hassan ◽  
Gustavo J Rodriguez ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Referral Patterns ◽  
Hospital Outcomes ◽  
Treatment Paradigm

Background: While single center and regional estimates of thrombolytic administration using drip and ship treatment paradigm are available, patient outcomes, thrombolytic utilization, cost, and referral patterns has not been assessed in United States. Objective: To provide national estimates of patients treated with thrombolytics using drip and ship paradigm and determine the impact of drip and ship treatment on regional thrombolytic utilization, treatment cost, and referral patterns of acute stroke patients in a large cohort. Methods: We determined the proportion of patients treated with drip and ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment and obtained comparative in-hospital outcomes from the Nationwide Inpatient Survey (NIS) data files from October 2008 to December 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Thrombolytic utilization, hospitalization cost, and patterns of referral related to drip and ship treatment of acute stroke were estimated. Results: Of the 26,814 ischemic stroke patients who received thrombolytic treatment, 5144 (19%) were treated using drip and ship paradigm. Seventy nine percent of all the drip and ship treated patients were referred to urban teaching hospitals for further care, and 7% of them received follow up endovascular treatment at the referral facility. States with higher proportion of patients treated using the drip and ship paradigm had higher rates of thrombolytic utilization (3.1% vs. 2.4%, p<0.001). After adjusting for age, gender, presence of hypertension, diabetes mellitus, renal failure, and hospital teaching status, outcomes of patients treated with drip and ship paradigm was similar to those who received thrombolytic and stayed in the same facility: self care (odds ratio [OR], 1.055, 95% confidence interval [CI], 0.910-1.224, p=0.4779); death(OR , 0.821 95% CI, 0.619- 1.088, p=0.1688); and nursing home discharge (OR, 1.023, 95% CI, 0.880- 1.189, p=0.7659) at discharge. Drip and ship paradigm was associated with shorter hospital stay (mean [days, SE] 5.9± 0.18 vs. 7.4 ± 0.15, p<0.001), and lower cost of hospitalization (mean total charges [$, SE) 57,000 ± 3,324 vs. 83,000 ± 3,367, p<0.001). Conclusions: One out of every five patients who received thromboytic treatment in United States is currently treated using drip and ship paradigm with comparable adjusted rates of favorable outcomes. There was a higher rates of thrombolytic utilization in States where drip and ship was more commonly implemented.

scholarly journals Drip-and-Ship Thrombolytic Treatment Paradigm Among Acute Ischemic Stroke Patients in the United States

Stroke ◽  
2012 ◽  
Vol 43 (7) ◽  
pp. 1971-1974 ◽  
Author(s):  
Wondwossen G. Tekle ◽  
Saqib A. Chaudhry ◽  
Ameer E. Hassan ◽  
Gustavo J. Rodriguez ◽  
M. Fareed K. Suri ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Treatment Paradigm

Abstract WP284: National Trends in Utilization and Outcomes of Thrombolytic Use by Drip and Ship Paradigm in Acute Ischemic Stroke Patients in United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Mohammad Rauf A Chaudhry ◽  
Mohsain Gill ◽  
Iqra N Akhtar ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Severe Disability ◽  
Multivariate Logistic Regression Model ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Hospital Outcomes

Background and Purpose: The drip and ship paradigm has rapidly expanded in the last decade allowing higher thrombolytic utilization and endovascular treatment. We performed this analysis to evaluate trends in utilization of drip and ship paradigm in United States and associated outcomes. Methods: We analyzed data for patients admitted with primary diagnosis of ischemic stroke in the United States from Nationwide Inpatient Sample, the largest nationally representative data, for the years 2009 to 2015. We studied changes in utilization of drip-and-ship paradigm and subsequent performance of endovascular treatment, and rates of discharge with none to minimal disability and moderate to severe disability. Results: Of the 3,043,190 patients admitted with ischemic stroke, 56,449 (1.85%) patients received thrombolytic treatment through drip-and-ship paradigm over a 7 year period. Of all patients who received thrombolytic treatment (n=243,824), 56,449 (23.15%) received using drip and ship paradigm. There was almost 3 fold increase in drip and ship paradigm (in 0.98% 2009 to 2.80% in 2015 (test for trend= p < 0.001). Among the patients who underwent drip and ship paradigm, 5,061 (8.97%) underwent endovascular treatment. The rate of endovascular treatment increased from 6.62% to 12.39% among patients treated with drip and ship paradigm (test for trend= p < 0.001). The rate of none minimal disability at discharge increased from 39.93% to 47.08%, (test for trend p < 0.001) while moderate to severe disability decreased 51.22% to 47.08%, (test for trend p < 0.001) in ischemic stroke patients treated using drip-and-ship paradigm. Similar trends were observed for hospital outcomes in multivariate logistic regression model, adjusted for age, gender, medical comorbidities and secondary intracranial hemorrhages. Conclusion: There has been a significant increase in the proportion of acute ischemic stroke patients treated using drip-and-ship paradigm (out of proportion to overall thrombolytic use) with increase in subsequent endovascular treatment in United States. The in hospital outcomes of patients have improved perhaps due to higher utilization of endovascular treatment.

Abstract 45: Thrombolytic Treatment for In-Hospital Ischemic Strokes in United States

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Tenbit Emiru ◽  
Malik M Adil ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Clinical Characteristics ◽  
The United States ◽  
Treated Group ◽  
Hospital Charges ◽  
Thrombolytic Treatment

BACKGROUND: Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on rates and outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. OBJECTIVE: To determine the rates of in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated with thrombolytics on admission. DESIGN/METHODS: We analyzed a seven-year data (2002-2009) from the National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. We identified patients who had in-hospital ischemic strokes (defined by thrombolytic treatment after one day of hospitalization) and those who received thrombolytics on the admission day. We compared demographics, baseline clinical characteristics, in hospital complications, length of stay, hospitalization charges, and discharge disposition, between the two patient groups. RESULT: A total of 18036 (21.5%) and 65912 (78.5%) patients received thrombolytics for in-hospital and on admission acute ischemic stroke, respectively. In hospital complications such as pneumonia (5.0% vs. 3.4%, p=0.0006), deep venous thrombosis (1.9% vs. 0.6%, p<0.0001) and pulmonary embolism (0.8% vs. 0.4%, p=0.01) were significantly higher in the in-hospital group compared to on admission thrombolytic treated group. Hospital length of stay and mean hospital charges were not different between the two groups. Patients who had in-hospital strokes had had higher rates of in hospital mortality (12.1% vs. 10.6%, p=0.02). In a multivariate analysis, in-hospital thrombolytic treated group had higher in-hospital mortality after adjustment for age, gender and baseline clinical characteristics (odds ratio 0.84, 95% confidence interval 0.74-0.95, p=0.008). CONCLUSION/RELEVANCE: In current practice, one out of every five acute ischemic stroke patients treated with thrombolytics is receiving treatment for in-hospital strokes. The higher mortality and complicated hospitalization in such patients needs to be recognized.

Abstract T P323: National Trends in Utilization and Outcomes of Intravenous Thrombolytic Treatment Among Pediatric Patients With Acute Ischemic Stroke in United States

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Taqi T Zafar ◽  
Mohammad Afzal ◽  
Malik M Adil ◽  
Gautam Sachdeva? ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Pediatric Patients ◽  
Fold Increase ◽  
Adverse Outcomes ◽  
P Value ◽  
Thrombolytic Treatment ◽  
Stroke Patients

Background: Thrombolytic treatment has been used with varying frequency among pediatric ischemic stroke patients. Objective: To evaluate trends in utilization of IV recombinant tissue plasminogen activator (rt-PA) and associated rates of death and disability among acute ischemic stroke patients over a six year period. Methods: We obtained data for pediatric patients (aged ≤18 years) admitted to United States in 2003, 2006 and 2009 with a primary diagnosis of ischemic stroke using the Nationwide Inpatient Sample (NIS-KID). We determined the rate and pattern of utilization, and associated in-hospital outcomes of IV-rt-PA including post-thrombolytic intracerebral hemorrhage (ICH) and rates death among pediatric ischemic stroke patients. Results: Of the 5,137 pediatric patients admitted with ischemic stroke, 48 (0.93%) received IV rt-PA during the study period. There was a 2.5 fold increase in rates of patients who received the thrombolytic treatment (0.53% in 2003, 0.87% in 2006 and 1.35% in 2009). The rate of post-thrombolytic ICH was 9.6% with no change in frequency over the three periods. The overall rate of post-thrombolytic intracerebral hemorrhage (ICH) was 9.6% with a trend towards decrease in rates (41%, 9.8%, and 0%) in 2003, 2006, and 2009. The overall rate of in hospital mortality was 9.6% with some decrease in rates (17.2%, 13.0%, and 5.9%, p value for trend=0.7). Conclusion: There has been a significant increase in the proportion of pediatric acute ischemic stroke patients receiving IV rt-PA treatment with some evidence of decrease in adverse outcomes at discharge.

Abstract WP54: National Trends in Utilization and Outcomes of Endovascular Treatment in Acute Ischemic Stroke Patients in Pre- and Post-Stent Retriever Era in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Ameer E Hassan ◽  
Iqra N Akhtar ◽  
Mohammad Rauf A Chaudhry ◽  
Wei Huang ◽  
...  
Keyword(s):  
United States ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
Stent Retriever ◽  
Severe Disability ◽  
Stroke Patients

Introduction: Several studies have shown improved outcomes in ischemic stroke patients treated with mechanical thrombectomy in clinical trials after introduction of stent retrievers. The outcomes of patients undergoing endovascular treatment in general practice are expected to improve. We performed this analysis to evaluate trends in utilization of endovascular treatment in acute ischemic stroke and associated rates of death and disability in real world practice. Methods: We obtained data for patients admitted with primary diagnosis of ischemic stroke in United States from 2009-2016 using Nationwide Inpatient Sample. We determined the rate and pattern of utilization, and associated in-hospital outcomes of endovascular treatment among them. Outcomes were classified as minimal disability, moderate to severe disability, and death based on discharge disposition and compared between two time periods: 2009-2011 and 2013-2016 to represent pre and post stent retriever approvals in United States. Results: Of the 3,780,955 patients admitted with ischemic stroke, 244,092 (6.46%) received intravenous thrombolytic treatment, and 48,409 (1.28%) underwent endovascular treatment. There was a fourfold increase in patients who underwent endovascular treatment (0.55% of ischemic strokes in 2009 vs. 2.03% in 2016, trend p < 0.001). In multivariate logistic regression analysis, adjusted for age, gender, thrombolytic therapy, in hospital complications including secondary intracranial hemorrhages, the rate of none to minimal disability improved between the two study intervals (2009-2011 versus 2013-2016), odds ratio (OR) 1.82, 95% confidence interval (CI) 1.47-2.67, p=<0.0001) and moderate to severe disability decreased (OR 0.56, 95% CI 0.45- 0.70, p= <0.0001). There was significant decrease inpatient mortality for patients treated during 2013-2016; OR 0.67, 95% CI 0.56- 0.79, p= <0.0001). Conclusion: There has been a significant increase in the proportion of acute ischemic stroke patients receiving endovascular treatment with improvement of outcomes. Our analysis support generalizability of the successful results observed in clinical trials of endovascular treatment in the post-stent retriever approval era in United States.

Sign in / Sign up

Export Citation Format

Share Document