Abstract 74: Transition To Tenecteplase From Alteplase Improves Ambulance And Interfacility Transfer Time Metrics In A Large Regional Healthcare System
| Autor: | Trevor E Cline, Navdeep S Sangha, Howard J Rho, Su-Jau Yang, Pamela Cheng, Duy Le, Zahra Ajani, Shayandokht Taleb |
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| Rok vydání: | 2023 |
| Předmět: | |
| Zdroj: | Stroke. 54 |
| ISSN: | 1524-4628 0039-2499 |
| Popis: | Introduction: The effect of tenecteplase (TNK) use on reducing interfacility transfer times and ambulance-based metrics for patients with a large vessel occlusion (LVO) eligible for endovascular thrombectomy (EVT) is not well studied. We analyzed how the administration of IV-TNK vs IV-tPA affected the Door In Door Out time (DIDO) as well as two novel ambulance-based metrics in patients arriving to the emergency department (ED) with an LVO who were transferred from 13 primary stroke centers to undergo EVT. Methods: Data were retrospectively abstracted for patients with an LVO from 09/2020 to 04/2022. Median DIDO times were calculated for patients who received no thrombolysis, tPA, and TNK. Subgroup analyses were performed for two novel time metrics, Door to Ambulance Arrival (DAA) and Ambulance Arrival to Ambulance Departure (AAAD), for patients that received IV thrombolysis. Statistical analysis was performed using the Wilcoxan rank sum and chi square tests. Results: There were 191 patients with AIS and an LVO. 130 received no IV thrombolysis and 62 received IV thrombolysis (32 tPA vs 29 TNK). There were no significant differences in baseline demographics between the thrombolysis and non-thrombolysis groups. Our sample was diverse in ethnicity with 60.7% being non-white. DIDO (TNK: 73 min {IQR 59-107} vs tPA: 106 min {IQR 88-137}, p = 0.01), DAA (TNK: 52.5 min {IQR 38-84} vs tPA: 77 min {IQR 61-105}, p = 0.03), and AAAD (TNK: 16.5 mins {IQR 10-22} vs tPA: 22 mins {IQR 18-40}, p = 0.01) were all faster for TNK cases compared to tPA cases. 58.5% of the TNK cases had a DIDO of ≤ 90 minutes vs 34.4% of tPA cases. Conclusions: Switching from IV-tPA to IV-TNK improved the DIDO by 33 minutes. This improvement was driven by two novel DIDO metrics: Door to Ambulance Arrival Time (DAA) and Ambulance Arrival to Ambulance Departure Time (AAAD) likely because the absence of a tPA infusion (drip & ship) allowed the use of non-critical care ambulances, which are more widely available, to transport patients. |
| Databáze: | OpenAIRE |
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