Abstract Details

Title The Elusive Golden Hour - A Multicenter Analysis of the Difficulties of Timely Intravenous Alteplase Treatment

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 189

Objective

Background BACKGROUND: The evaluation of an acute ischemic stroke patient for administration of thrombolytic therapy is multifaceted with many points of possible delay. However, the benefit of thrombolytic therapy is strongly time dependent. We explore why a 60 minute door to needle time is elusive.

Design/Methods DESIGN/METHODS: We analyzed prospectively collected acute stroke patient treatment timelines for 12 consecutive months from two institutions for successful 60 minute thrombolytic treatment times and reasons for treatment delays. Reasons for delay were classified into the following categories: patient stabilization needed, imaging delay, confusing clinical presentation, lab delay, triage/stroke team activation delay, Neurologist delay, family delay, and pharmacy delay.

Results RESULTS: Between May 2011- May 2012, we identified 89 patients who presented with acute ischemic stroke symptoms, were eligible for, and received intravenous alteplase treatment. Of these, 50 % received IV thrombolytic within 60 minutes from presentation to the ER (median 59, 14-194). The reasons for delay in order of occurrence were patient stabilization needed (13% ), confusing clinical presentation( 13%), imaging delay (11%), triage/stroke team activation delay (7%), lab delay (3%), Neurology delay (3%), and family delay (1%). 4% of delays were multifactorial.

Conclusions CONCLUSIONS: Many factors contribute to delay in IV thrombolytic treatment in the acute stroke patient. In many patients when stabilization is needed or when the clinical presentation is confusing, it may be in the patient's best interest to delay thrombolytics until the situation is clarified. We must strive to identify causes of delay in our institutions to maintain maximum benefit of thrombolytic therapy for our patients.

Authors/Disclosures
Rebecca L. Sugg, MD, FAAN (The University of South Alabama Medical Center) PRESENTER	Dr. Sugg has nothing to disclose.
	No disclosure on file
Shirley Chen, DO (Memorial Regional Hospital)	No disclosure on file
As'ad Ehtisham, MD (Ehtisham Neurovascular Institute, PLLC)	No disclosure on file
	No disclosure on file
Marilyn M. Rymer, MD	No disclosure on file
Steven T. DeKosky, MD, FAAN (McKnight Brain Institute)	Dr. DeKosky has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acumen. Dr. DeKosky has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. DeKosky has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cognition Therapeutics. Dr. DeKosky has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Prevail Pharamceuticls. Dr. DeKosky has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Vaccinex, Inc. Dr. DeKosky has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up-To-Date. Dr. DeKosky has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurotherapeutics .

��ɫ��

��ɫ��