Abstract 85: The Important Role of Drip and Ship Administration in Expanded Use of Thrombolytic Therapy in the United States

Abstract

Introduction: Interhospital transfer after use of IV tissue plasminogen activator (tPA) in acute stroke (“drip and ship”) may be increasing, but there are limited data on national trends. Methods: We analyzed data from 44,667 patients with ischemic stroke treated with IV tPA <3 hours of symptom onset in the Get With The Guidelines-Stroke Program from 2003-2010 in 1440 hospitals. The main outcomes were the frequency of “drip and ship” tPA use over time. Patient and hospital-level characteristics including bed size, geographic region, academic status, ischemic stroke volume, and Joint Commission primary stroke center certification (PSC) were collected. Results: Amongst 44,667 tPA patients, drip and ship was a common method (n=10,475; 23.5%). The median age was 72 years, 49% were women, 12% were Black and 5% Hispanic. The percentage of all tPA eligible patients treated via drip and ship increased during the study period (4.0% to 7.6%, p<.0001) (Figure 1). Compared to front door patients, drip and ship patients were younger, more often male, and more often white. Drip and ship patients were more likely to arrive off hours (outside of Monday-Friday, 7 AM-5 PM) (71% vs 53%, p<.0001). Hospitals that received drip and patients, compared to hospitals with predominantly front door patients, had more beds (488 vs 385, p<.0001), were more likely to be an academic medical center (81% vs 61%, p<.0001), have a higher volume of annual ischemic stroke cases (273 vs 206, p < .0001) and more likely be PSC (70% vs 63%, p<.0001). As a proportion, drip and ship hospitals were more common in the Midwest. Discussion: In the largest study of its kind to date, these results show that the drip and ship method of intravenous tPA treatment accounts for one out of every four acute ischemic stroke patients treated with tPA in GWTG hospitals. These results suggest that drip and ship is an important strategy to bring the benefits of tPA treatment to patients.