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Delay in hospital presentation is the main reason large vessel occlusion stroke patients do not receive intravenous thrombolysi
OBJECTIVES: Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are the mainstays of treatment for large vessel occlusion stroke (LVOS). Prior studies have examined why patients have not received IVT, the most cited reasons being last‐known‐well (LKW) to hospital arrival of >4.5 hours a...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568043/ https://www.ncbi.nlm.nih.gov/pubmed/37840864 http://dx.doi.org/10.1002/emp2.13048 |
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author | Brandler, Ethan S. Isenberg, Derek L. Herres, Joseph Zhao, Huaqing Kraus, Chadd K. Ackerman, Daniel Sigal, Adam Kuc, Alexander Nomura, Jason T. Wojcik, Susan Mullen, Michael T. Gentile, Nina T. |
author_facet | Brandler, Ethan S. Isenberg, Derek L. Herres, Joseph Zhao, Huaqing Kraus, Chadd K. Ackerman, Daniel Sigal, Adam Kuc, Alexander Nomura, Jason T. Wojcik, Susan Mullen, Michael T. Gentile, Nina T. |
author_sort | Brandler, Ethan S. |
collection | PubMed |
description | OBJECTIVES: Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are the mainstays of treatment for large vessel occlusion stroke (LVOS). Prior studies have examined why patients have not received IVT, the most cited reasons being last‐known‐well (LKW) to hospital arrival of >4.5 hours and minor/resolving stroke symptoms. Given that LVOS patients typically present moderate‐to‐severe neurologic deficits, these patients should be easier to identify and treat than patients with minor strokes. This investigation explores why IVT was not administered to a cohort of LVOS patients who underwent EVT. METHODS: This is an analysis of the Optimizing the Use of Prehospital Stroke Systems of Care (OPUS‐REACH) registry, which contains patients from 9 endovascular centers who underwent EVT between 2015 and 2020. The exposure of interest was the receipt of intravenous thrombolysis. Descriptive summary statistics are presented as means and SDs for continuous variables and as frequencies with percentages for categorical variables. Two‐sample t tests were used to compare continuous variables and the chi‐square test was used to compare categorical variables between those who received IVT and those who did not receive EVT. RESULTS: Two thousand forty‐three patients were included and 60% did not receive IVT. The most common reason for withholding IVT was LKW to arrival of >4.5 (57.2%). The second most common contraindication was oral anticoagulation (15.5%). On multivariable analysis, 2 factors were associated with not receiving IVT: increasing age (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.78–0.93) and increasing time from LKW‐to hospital arrival (OR 0.45 95% CI 0.46–0.49). CONCLUSION: Like prior studies, the most frequent reason for exclusion from IVT was a LKW to hospital presentation of >4.5 hours; the second reason was anticoagulation. Efforts must be made to increase awareness of the time‐sensitive nature of IVT and evaluate the safety of IVT in patients on oral anticoagulants. |
format | Online Article Text |
id | pubmed-10568043 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-105680432023-10-13 Delay in hospital presentation is the main reason large vessel occlusion stroke patients do not receive intravenous thrombolysi Brandler, Ethan S. Isenberg, Derek L. Herres, Joseph Zhao, Huaqing Kraus, Chadd K. Ackerman, Daniel Sigal, Adam Kuc, Alexander Nomura, Jason T. Wojcik, Susan Mullen, Michael T. Gentile, Nina T. J Am Coll Emerg Physicians Open Neurology OBJECTIVES: Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are the mainstays of treatment for large vessel occlusion stroke (LVOS). Prior studies have examined why patients have not received IVT, the most cited reasons being last‐known‐well (LKW) to hospital arrival of >4.5 hours and minor/resolving stroke symptoms. Given that LVOS patients typically present moderate‐to‐severe neurologic deficits, these patients should be easier to identify and treat than patients with minor strokes. This investigation explores why IVT was not administered to a cohort of LVOS patients who underwent EVT. METHODS: This is an analysis of the Optimizing the Use of Prehospital Stroke Systems of Care (OPUS‐REACH) registry, which contains patients from 9 endovascular centers who underwent EVT between 2015 and 2020. The exposure of interest was the receipt of intravenous thrombolysis. Descriptive summary statistics are presented as means and SDs for continuous variables and as frequencies with percentages for categorical variables. Two‐sample t tests were used to compare continuous variables and the chi‐square test was used to compare categorical variables between those who received IVT and those who did not receive EVT. RESULTS: Two thousand forty‐three patients were included and 60% did not receive IVT. The most common reason for withholding IVT was LKW to arrival of >4.5 (57.2%). The second most common contraindication was oral anticoagulation (15.5%). On multivariable analysis, 2 factors were associated with not receiving IVT: increasing age (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.78–0.93) and increasing time from LKW‐to hospital arrival (OR 0.45 95% CI 0.46–0.49). CONCLUSION: Like prior studies, the most frequent reason for exclusion from IVT was a LKW to hospital presentation of >4.5 hours; the second reason was anticoagulation. Efforts must be made to increase awareness of the time‐sensitive nature of IVT and evaluate the safety of IVT in patients on oral anticoagulants. John Wiley and Sons Inc. 2023-10-11 /pmc/articles/PMC10568043/ /pubmed/37840864 http://dx.doi.org/10.1002/emp2.13048 Text en © 2023 The Authors. Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Neurology Brandler, Ethan S. Isenberg, Derek L. Herres, Joseph Zhao, Huaqing Kraus, Chadd K. Ackerman, Daniel Sigal, Adam Kuc, Alexander Nomura, Jason T. Wojcik, Susan Mullen, Michael T. Gentile, Nina T. Delay in hospital presentation is the main reason large vessel occlusion stroke patients do not receive intravenous thrombolysi |
title | Delay in hospital presentation is the main reason large vessel occlusion stroke patients do not receive intravenous thrombolysi |
title_full | Delay in hospital presentation is the main reason large vessel occlusion stroke patients do not receive intravenous thrombolysi |
title_fullStr | Delay in hospital presentation is the main reason large vessel occlusion stroke patients do not receive intravenous thrombolysi |
title_full_unstemmed | Delay in hospital presentation is the main reason large vessel occlusion stroke patients do not receive intravenous thrombolysi |
title_short | Delay in hospital presentation is the main reason large vessel occlusion stroke patients do not receive intravenous thrombolysi |
title_sort | delay in hospital presentation is the main reason large vessel occlusion stroke patients do not receive intravenous thrombolysi |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568043/ https://www.ncbi.nlm.nih.gov/pubmed/37840864 http://dx.doi.org/10.1002/emp2.13048 |
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