Abstract 200: Team of Neurohospitalists, Telestroke, and Nurse Stroke Coordinator Increases the Use of Intravenous Alteplase in a Community Hospital

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
H. McCord Smith ◽  
C. Van Morris ◽  
Shelley Nichols ◽  
Joanne Lockamy ◽  
Jeffrey A Switzer ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Community Hospital ◽  
Standard Of Care ◽  
Favorable Outcome ◽  
Full Time ◽  
Short Supply ◽  
Safety And Efficacy ◽  
Model Combining ◽  
Intravenous Alteplase ◽  
Iv Tpa

Background and Purpose: The FDA approved IV tPA in 1996 for the treatment of AIS. Its safety and efficacy have been demonstrated in community hospitals (CH) and it is now the standard of care; but intravenous Alteplase (IV tPA) remains underemployed. It is used in fewer than 5% of AIS patients. Short supply of neurologic manpower and concern over adverse effect contribute to this underutilization. Our hypothesis was that a combination of onsite neurohospitalists (NH), telestroke (TS), nurse stroke coordinator (NC), and education of staff and community would increase IV tPA use in a mid-sized CH PSC without compromise of safety or outcome. Methods: The hospital is a 197 bed nonprofit hospital located 60 miles from Atlanta serving a population of 350,000 in 10 counties. The hospital has been certified as a PSC since August 2004; however, the volume of AIS admissions and use of IV tPA remained low through 2008. The stroke program thus was reorganized in 2009: two full-time NH were hired to provide onsite coverage daily from 8am to 6pm, the REACH™ TS System was installed to provide the remainder of coverage, a NC was hired, and an education plan for staff and community was implemented. Patients treated with IV tPA via TS were admitted to the neuro-ICU by medical hospitalists initially with NH assuming primary care of these patients within hours. AIS admission and IV tPA use data for 2002- 2008 were compared with those for 2009 - 2012. Outcomes, assessed at discharge, 2009 - 2012 were also examined. Favorable outcome was defined as a mRS of 0 or 1. Results: From 2002-2008, 25 of 933 AIS were treated with IV tPA: 3.6 per year (2.7%). In contrast, from 2009-2012, 105 of 802 AIS received IV tPA: 26.25 per year (13%) with favorable outcome in 47 (45%). Of 64 patients treated by NH, 28 (44%) achieved favorable outcome as did 19 of 41 (46%) TS patients. These outcomes were not statistically different (p=0.92). There were 5 deaths (3 NH, 2 TS), none attributable to tPA. There were no sICH. Conclusions: A model combining NH, TS, NC, and education in a CH PSC significantly increased the use of IV tPA without compromising safety or effectiveness. Such a model may be an option where resources are limited.

scholarly journals Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Benedikt M. Frey ◽  
◽  
Florent Boutitie ◽  
Bastian Cheng ◽  
Tae-Hee Cho ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Antiplatelet Treatment ◽  
Safety And Efficacy ◽  
History Of ◽  
Intravenous Alteplase

Abstract Background One quarter to one third of patients eligible for systemic thrombolysis are on antiplatelet therapy at presentation. In this study, we aimed to assess the safety and efficacy of intravenous thrombolysis in stroke patients on prescribed antiplatelet therapy in the WAKE-UP trial. Methods WAKE-UP was a multicenter, randomized, double-blind, placebo-controlled clinical trial to study the efficacy and safety of MRI-guided intravenous thrombolysis with alteplase in patients with an acute stroke of unknown onset time. The medication history of all patients randomized in the WAKE-UP trial was documented. The primary safety outcome was any sign of hemorrhagic transformation on follow-up MRI. The primary efficacy outcome was favorable functional outcome defined by a score of 0–1 on the modified Rankin scale at 90 days after stroke, adjusted for age and baseline stroke severity. Logistic regression models were fitted to study the association of prior antiplatelet treatment with outcome and treatment effect of intravenous alteplase. Results Of 503 randomized patients, 164 (32.6%) were on antiplatelet treatment. Patients on antiplatelet treatment were older (70.3 vs. 62.8 years, p <  0.001), and more frequently had a history of hypertension, atrial fibrillation, diabetes, hypercholesterolemia, and previous stroke or transient ischaemic attack. Rates of symptomatic intracranial hemorrhage and hemorrhagic transformation on follow-up imaging did not differ between patients with and without antiplatelet treatment. Patients on prior antiplatelet treatment were less likely to achieve a favorable outcome (37.3% vs. 52.6%, p = 0.014), but there was no interaction of prior antiplatelet treatment with intravenous alteplase concerning favorable outcome (p = 0.355). Intravenous alteplase was associated with higher rates of favorable outcome in patients on prior antiplatelet treatment with an adjusted odds ratio of 2.106 (95% CI 1.047–4.236). Conclusions Treatment benefit of intravenous alteplase and rates of post-treatment hemorrhagic transformation were not modified by prior antiplatelet intake among MRI-selected patients with unknown onset stroke. Worse functional outcome in patients on antiplatelets may result from a higher load of cardiovascular co-morbidities in these patients.

MRI-guided Thrombolysis for Lenticulostriate Artery Stroke within 12 Hours after the Onset of Symptoms

2019 ◽  
Author(s):  
jianying zhang ◽  
Qingke Bai ◽  
Zhenguo Zhao ◽  
Yiting Mao ◽  
Qiang Dong ◽  
...  
Keyword(s):  
Demographic Data ◽  
Group Iv ◽  
Favorable Outcome ◽  
Ischemic Lesion ◽  
Intravenous Alteplase ◽  
Lenticulostriate Artery ◽  
Mri Guided ◽  
Magnetic Resonance Imaging Mri ◽  
Favorable Clinical Outcome ◽  
Iv Tpa

Abstract Background and purpose: We sought to analyze the efficacy of magnetic resonance imaging (MRI)-guided thrombolysis in patients with lenticulostriate artery stroke (LSAS) within 12 hours after onset of symptoms. Methods: LSAS patients identified on diffusion-weighted imaging (DWI) within 12h after onset of symptoms were assigned to receive intravenous alteplase (iv-tPA). DWI/ T2-weighte imaging (T2WI) mismatch -/+ was defined as an acute ischemic lesion on DWI with/without a corresponding lesion on T2WI in the territory of lenticulostriate artery. Favorable clinical outcome was defined as modified Rankin Scale (mRS) score <2 at 90 days. Baseline demographic data and medical history were compared between outcomes. Results: There were 160 LSAS patients received iv-tPA (104 within 4.5h) in 2008-2018 who had MRI data before treatment. DWI/T2WI-mismatch was detected in 73.1% (117/160) of patients. Lower admission systolic blood pressure (SBP) was significantly associated with 90d mRS<2 [adjusted odds ratio (OR) 0.93, 95%CI 0.88-0.99, p=0.026]. In overall patients, whether they received iv-tPA within 4.5h or not and whether they had DWI/T2WI-mismatch or not did not significantly impact the outcome. In DWI/T2WI-mismatch (+) group, hypertension negatively associated with favorable outcome (adjusted OR 0.15, 95% CI 0.04-0.59, p=0.007). In DWI/T2WI-mismatch (-) group, iv-tPA within 4.5h was an independent predictor of 90d mRS<2 (adjusted OR 7.38, 95% CI 1.25-43.48, p=0.027).Conclusion: MRI-guided iv-tPA within 12h is safe and effective for LSAS patients. Hypertension and higher admission SBP are associated with poor outcome. In patients who have no DWI/T2WI-mismatch, iv-tPA within 4.5h independently predicts favorable outcome.

scholarly journals A Phase II Safety and Efficacy Study on Prognosis of Moderate Pneumonia in COVID-19 patients with Regular Intravenous Immunoglobulin Therapy

2021 ◽  
Author(s):  
Raman R S ◽  
Vijaykumar Bhagwan Barge ◽  
Anil Kumar Darivenula ◽  
Himanshu Dandu ◽  
Rakesh R Kartha ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Study ◽  
Standard Of Care ◽  
Immunoglobulin Therapy ◽  
Clinical Trial Registry ◽  
Open Label ◽  
Intravenous Immunoglobulin Therapy ◽  
Safety And Efficacy ◽  
Therapeutic Benefits ◽  
Wide Range

Abstract Background Currently, there is no specific drug for the treatment of COVID-19. Therapeutic benefits of intravenous immunoglobin (IVIG) have been demonstrated in wide range of diseases. The present study is conducted to evaluate the safety and efficacy of IVIG in the treatment of COVID-19 patients with moderate pneumonia. Methods An open-label, multicenter, comparative, randomized study was conducted on COVID-19 patients with moderate pneumonia. 100 eligible patients were randomized in 1:1 ratio either to receive IVIG + standard of care (SOC) or SOC. Results Duration of hospital stay was significantly shorter in IVIG group to that of SOC alone (7.7 Vs. 17.5 days). Duration for normalization of body temperature, oxygen saturation and mechanical ventilation were significantly shorter in IVIG compared to SOC. Percentages of patients on mechanical ventilation in two groups were not significantly different (24% Vs. 38%). Median time to RT-PCR negativity was significantly shorter with IVIG than SOC (7 Vs.18 days). There were only mild to moderate adverse events in both groups except for one patient (2%), who died in SOC. Conclusions IVIG was safe and efficacious as an adjuvant with other antiviral drugs in the treatment of COVID-19. The trial was registered under Clinical Trial Registry, India (CTRI/2020/06/026222).

Safety and Efficacy of Transcarotid Artery Revascularization in a Community Hospital

2020 ◽  
Author(s):  
Aaron Zebolsky ◽  
Jesse Chou ◽  
Phillip Key ◽  
Patrick Knight ◽  
Gulrez Mahmood ◽  
...  
Keyword(s):  
Community Hospital ◽  
Safety And Efficacy

scholarly journals Comparison of Pharmacist-Directed Management of Multiplex PCR Blood Culture Results with Conventional Microbiology Methods on Effective and Optimal Therapy within a Community Hospital

2018 ◽  
Vol 63 (1) ◽  
Author(s):  
Allison M. Porter ◽  
Christopher M. Bland ◽  
Henry N. Young ◽  
David R. Allen ◽  
Sabrina R. Croft ◽  
...  
Keyword(s):  
Blood Culture ◽  
Multiplex Pcr ◽  
Positive Blood Culture ◽  
Antimicrobial Therapy ◽  
Community Hospital ◽  
Intervention Group ◽  
Standard Of Care ◽  
Pharmacist Intervention ◽  
Coagulase Negative Staphylococcus ◽  
Optimal Therapy

ABSTRACT Multiplex PCR combined with a pharmacist-driven reporting protocol was compared to the standard of care within a community hospital to evaluate initial changes after notification of a positive blood culture. The intervention group demonstrated decreased times to changes in antimicrobial therapy (P = 0.0081), increased changes to optimal antimicrobial therapy (P = 0.013), and decreased vancomycin use for coagulase-negative staphylococcus contaminants (P < 0.01) with multiplex PCR implementation and pharmacist intervention.

Letter to the Editor

PEDIATRICS ◽  
1972 ◽  
Vol 50 (3) ◽  
pp. 497-497
Author(s):  
Charles D. Cook ◽  
Raymond S. Duff
Keyword(s):  
Community Hospital ◽  
Hospital Admissions ◽  
House Staff ◽  
Full Time ◽  
Ivory Tower ◽  
Community Hospitals ◽  
Educational Value ◽  
Professional Groups ◽  
Letter To The Editor

We certainly agree with Dr. Rako that a fulltime Chief of Pediatrics in a Community Hospital should decrease unnecessary hospital admissions. We currently have an opportunity to reexamine the admission practices of one of the community hospitals studied earlier to see if such is the case; our preliminary findings suggest that the full-time chief, without a critical house staff, may have disappointingly little influence on the criteria used for admission. In regard to the comment of "I. M. Tired": we are having pediatricians from community hospitals review records from the "Ivory Tower" and from the community hospitals; hopefully this will have an educational value for both professional groups.

Mechanical thrombectomy versus intravenous alteplase alone in acute isolated posterior cerebral artery occlusion: a systematic review

2021 ◽  
pp. neurintsurg-2021-018017
Author(s):  
Andre Monteiro ◽  
Slah Khan ◽  
Muhammad Waqas ◽  
Rimal H Dossani ◽  
Nicco Ruggiero ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Posterior Cerebral Artery ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Intravenous Tissue Plasminogen Activator ◽  
Significant Difference ◽  
Symptomatic Intracranial Hemorrhage ◽  
Cerebral Artery Occlusion ◽  
Iv Tpa

BackgroundAcute isolated posterior cerebral artery occlusions (aPCAOs) were excluded or under-represented in major randomized trials of mechanical thrombectomy (MT). The benefit of MT in comparison to intravenous tissue plasminogen activator (alteplase; IV-tPA) alone in these patients remains controversial and uncertain.MethodsWe performed a systematic search of PubMed, MEDLINE, and EMBASE databases for articles comparing MT with or without bridging IV-tPA and IV-tPA alone for aPCAO using keywords (‘posterior cerebral artery’, ‘thrombolysis’ and ‘thrombectomy’) with Boolean operators. Extracted data from patients reported in the studies were pooled into groups (MT vs IV-tPA alone) for comparison. Estimated rates for favorable outcome (modified Rankin scale score 0–2), symptomatic intracranial hemorrhage (sICH), and mortality were extracted.ResultsSeven articles (201 MT patients, 64 IV-tPA) were included, all retrospective. There was no statistically significant difference between pooled groups in median age, median presentation National Institutes of Health Stroke Scale (NIHSS) score, PCAO segment, and median time from symptom onset to puncture or needle. The recanalization rate was significantly higher in the MT group than the IV-tPA group (85.6% vs 53.1%, p<0.00001). Odds ratios for favorable outcome (OR 1.5, 95% CI 0.8 to 2.5), sICH (OR 1.1, 95% CI 0.2 to 5.5), and mortality (OR 1.4, 95% CI 0.5 to 3.6) did not significantly favor any modality.ConclusionsWe found no significant differences in odds of favorable outcome, sICH, and mortality in MT and IV-tPA in comparable aPCAO patients, despite superior MT recanalization rates. Equipoise remains regarding the optimal treatment modality for these patients.

Abstract TP12: The Trend of Successful First Pass in M2 Segment Stroke Thrombectomy- Insights From the STAR Collaboration

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Eyad Almallouhi ◽  
Sami Al kasab ◽  
Ali Alawieh ◽  
Reda M Chalhoub ◽  
Marios Psychogios ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Independent Predictor ◽  
Star Collaboration ◽  
Stroke Patients ◽  
First Pass ◽  
Thrombectomy Device ◽  
Intravenous Alteplase ◽  
Multicenter Registry ◽  
Over Time ◽  
Iv Tpa

Introduction: Stroke thrombectomy devices and the experience of neurointerventionists have improved significantly over the last few years making targeting distal occlusions such as of the M2 segment of the middle cerebral artery more feasible. We aimed to study the trend in the successful first pass (SFP) of M2 occlusions over time using the data from a contemporary multicenter registry. Methods: We reviewed the data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which included data from 11 thrombectomy-capable stroke centers to identify stroke patients who underwent mechanical thrombectomy of M2 segment occlusion. SFP was defined by achieving modified Thrombolysis in Cerebral Infarction (mTICI) score≥2b with a single thrombectomy device pass. We analyzed the linear trendline of the rate of SFP over time. Then, we used a logistic regression model to assess predictors of SFP of M2 segment occlusion. Results: We included 401 patients who underwent stroke thrombectomy of M2 occlusion; median age was 71 (IQR 60-80), 212 (52.9%) were females, 174 (43.4%) were white, National Institute of Health stroke scale (NIHSS) was 14 (IQR 8-19), Alberta Stroke Program Early CT (ASPECT) score on presentation was 9 (IQR 7-10) and onset wot groin time was 287 (IQR 181-454). SFP was achieved in 118 (29.4%) patients (linear trendline over time is in Figure 1). Presenting after 2014 was an independent predictor of SFP (OR 1.9, 95% CI 1.1-3.2, P=0.019) after controlling for age, sex, NIHSS on presentation, intravenous alteplase (IV-tPA), and onset to groin time. Conclusion: SFP rate of M2 segment occlusion has increased after 2014 likely secondary the improvement in stroke thrombectomy devices and neurointerventionists experience.

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