Abstract T P203: Tissue Plasminogen Activator is Safe Via Telemedicine for Treatment of Mild Acute Ischemic Stroke

Abstract

Objective: Telemedicine (TM) has increased the use of intravenous (IV) tissue plasminogen activator (tPA) for treatment of acute ischemic stroke. Administration of tPA via TM has been shown to be safe when given in the setting of established treatment guidelines. Debate exists regarding the use of tPA in patients deemed to have “mild” stroke. We report our study demonstrating the safety of tPA via TM for mild stroke. Methods: In this retrospective chart review from 4/12 to 4/13, we identified 137 patients who were given IV-tPA via TM in our 14 spoke network. Baseline characteristics and clinical variables were abstracted. We defined mild stroke by NIHSS of ≤4. Poor outcomes were defined as symptomatic intracranial hemorrhage (sICH), neurological worsening (an increase in NIHSS of ≥2 points regardless of cause of decline), angioedema, and death. Logistic regression analysis was performed between groups with NIHSS≤4 and NIHSS>4. Results: Table 1 depicts baseline characteristics. Of 137 patients, 27 presented with an NIHSS≤4 (20%) and 110 with an NIHSS>4 (80%). Although rates of sICH were higher in patients with NIHSS>4 compared to those with NIHSS≤4, there was no significant difference (1.8% vs 0%) (Table 2). There was no significant difference in the rates of neurologic worsening between mild (3.7%) and severe strokes (7.3%) (p<0.69). While rates of angioedema were higher in patients with severe stroke, this increment was not significant (0.9% vs 0%) (Table 2). Four deaths occurred in the severe stroke group compared to none in the mild stroke group, with no significant difference (Table 2). Conclusion: Our results suggest that IV tPA given via TM did not increase the risk of complications in patients with mild stroke. However, our sample size was small and we cannot rule out that some of the mild stroke patients had stroke mimics. Our results support using TM to enroll patients at community hospitals in the upcoming PRISM trial testing the efficacy of tPA in patients with mild stroke.