Abstract Details

Title Time to Dual Antiplatelet Administration in Patients With Minor Ischemic Stroke

Topic Neurohospitalist

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 2-014

Objective To evaluate sources of treatment delay in the administration of dual antiplatelet therapy (DAPT) to patients with minor acute ischemic stroke (AIS).

Background Delayed and missed administration of DAPT after minor AIS (NIHSS <6) are frequent in clinical practice despite evidence-based guidelines. We hypothesized that obtaining advanced neuroimaging was a source of DAPT delay at our center.

Design/Methods We conducted a retrospective cohort study of consecutive minor AIS patients eligible for DAPT based on current guidelines from 1/1/2023-5/31/2023 at our comprehensive stroke center (CSC) and an affiliated primary stroke center (PSC) with more limited access to advanced neuroimaging. Patients’ demographics and relevant time metrics, including arrival-to-imaging and arrival-to-treatment, were calculated and compared.

Results Of 136 patients with minor AIS, 52 met inclusion criteria (31 CSC, 21 PSC). Overall, 40% were female, mean age was 67.5 (SD 13.8) years, and the median NIHSS was 1 (IQR 0-3). The mean arrival-to-treatment time was 665 (SD 457) minutes; this interval did not differ by site (663 [SD 442] vs 669 [SD 489] minutes; p=0.97). Mean time-to-brain MRI was 434 (SD 370) minutes. Three patients (2 CSC, 1 PSC) did not undergo MRI and 11 (5 CSC, 6 PSC) received DAPT before MRI. Patients given DAPT prior to MRI had significantly faster treatment times than those treated after MRI (205.6 [SD 131.6] vs 788.7 [SD 433.9] minutes; p<0.001). Non-contrast head CT was obtained in all patients and CT angiogram (CTA) obtained in 19 patients (13 CSC, 6 PSC). The mean time to CTA was 171.26 (SD 241.61) minutes. No patients received DAPT prior to CT or CTA.

Conclusions Among eligible minor stroke patients, average time from ED arrival to DAPT initiation was nearly 11 hours. Patients who received DAPT prior to MR brain were treated significantly faster, suggesting that waiting for advanced imaging may contribute to treatment delays.

Authors/Disclosures
Kara Farnes, MD (NYP-Weill Cornell) PRESENTER	Dr. Farnes has nothing to disclose.
Samuel Bruce, MD (New York Presbyterian-Weill Cornell Medical Center)	Dr. Bruce has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for TETMedical. Dr. Bruce has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ��ɫ��. The institution of Dr. Bruce has received research support from Alnylam Pharmaceuticals.
Babak Navi, MD (Weill Cornell Medical College)	Dr. Navi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MindRhythm Inc. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for multiple medicolegal firms.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.
Ava L. Liberman, MD (Weill Cornell Medicine)	Dr. Liberman has nothing to disclose.

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