Abstract NS7: Time To Reversal Is Brain - A Retrospective Analysis Of Door To Needle Times Of Anticoagulation Reversal Agents In Intracranial Hemorrhage, A Single Center Retrospective Analysis

Abstract

Objectives: Anticoagulant associated intracranial hemorrhage (AA-ICrH) accounts for 10-25% of all intracranial hemorrhages and anticoagulation (AC) at the time of the event more than doubles mortality risk. No guidelines for target times to treatment have been established for the administration of AC reversal agents despite their rapid onset of action. We evaluated AC reversal treatment times among patients with AA-ICrH presenting to a single large community hospital with institutional target times established in 2018. Methods: Retrospective chart review was performed for all AA-ICrH treated with reversal agents in Sarasota Memorial Hospital Comprehensive Stroke Center, Sarasota, Florida, between 2018-2021. Clinical and non-clinical variables were collected. Predictors with p<0.20 in the univariate analysis were investigated further in a multivariable model. Results: We identified 175 patients, 60% male, 94% Caucasian. FXa inhibitors were used among 67%, warfarin 29% and dabigatran 4%. Half the cohort was treated with andexanet, 46% PCCs and 4% idarucizumab. Arriving via EMS, 70%, transfers from other facilities 14%, walk-ins 10%, and inpatients 6%. Overall, 62% arrived ≤3 hours from symptom onset, 52% and 20% presented under trauma alert (TA) and stroke alert (SA) protocols, respectively. Overall median [IQR] DTN and CTN times (in minutes) were 103 [69-182] and 81 [55-126] respectively, and order-to-needle time, 38 [31-46]. DTN and CTN times among EMS arrival were 98 [69-160] and 70 [54- 110], respectively, for walk-ins, 204 [144-262] and 88 [66-130], respectively (p<0.05). DTN ≤90 and ≤60 minutes was seen in 69% and 38% of SA and 48% and 14% of TA, respectively. CTN ≤60 minutes was achieved in 58% of SA and 35% of TA. The only two significant independent predictors of faster DTN times were SA protocol on arrival and arrival mode (p<0.001). Conclusions: Similar to ischemic strokes, arrival by EMS or under SA protocol was associated with faster DTN and CTN times for AC reversal therapies in patients presenting with AA-ICrH. Our institution’s proposed time goals for DTN ≤90 and CTN ≤60 minutes for >75% of patients remained unmet. Nationally accepted target times for AC reversal therapies used in certified stroke centers could help achieve these goals.