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

Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 420 Delaware Street SE, MMC 295, Minneapolis, MN 55455, USA.
Stroke (Impact Factor: 5.72). 06/2012; 43(7):1971-4. DOI: 10.1161/STROKEAHA.112.657817
Source: PubMed


To provide a national assessment of thrombolytic administration using drip-and-ship treatment paradigm.
Patients treated with the drip-and-ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment were identified within the Nationwide Inpatient Sample. Thrombolytic utilization, patterns of referral, comparative in-hospital outcomes, and hospitalization charges related to drip-and-ship paradigm were determined. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis.
Of the 22 243 ischemic stroke patients who received thrombolytic treatment, 4474 patients (17%) were treated using drip-and-ship paradigm. Of these 4474 patients, 81% were referred to urban teaching hospitals for additional care, and 7% of them received follow-up endovascular treatment. States with a higher proportion of patients treated using the drip-and-ship paradigm had higher rates of overall thrombolytic utilization (5.4% versus 3.3%; P<0.001). The rate of home discharge/self-care was significantly higher in patients treated with drip-and-ship paradigm compared with those who received thrombolytics through primary emergency department arrival in the multivariate analysis (OR, 1.198; 95% CI, 1.019-1.409; P=0.0286).
One of every 6 thrombolytic-treated patients in United States is treated using drip-and-ship paradigm. States with the highest proportion of drip-and-ship cases were also the states with the highest thrombolytic utilization.

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Available from: Ameer E Hassan, Oct 27, 2015
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    • "The drip-and-ship treatment paradigm involves commencing IV tPA in stroke patients in smaller community hospitals prior to transfer to larger tertiary stroke centres to undergo IA therapy [32]. While this has been shown to be a safe treatment strategy, it may worsen onset-to-treatment times [33]. "
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