Abstract WMP20: Forget The Drip, Just Bolus And Ship: A Regional Initiative To Shift From Alteplase To Tenecteplase And Its Effect On Door-in-door-out Time

Abstract

Background and Purpose: In order to provide efficient and effective stroke care, The American Stroke Association recommends establishing stroke systems of care. Standardizing stroke care from a regional approach ensures patients receive consistent, evidence-based care. Many community and critical access hospitals lack resources needed for rapid transfer to the regional comprehensive stroke center (CSC) after treatment of an acute ischemic stroke. Single-bolus administration of IV tenecteplase (TNK) in community and critical access hospitals allows for immediate transfer of patients without the necessity of an hour-long infusion. There is supporting evidence for the use of TNK as an alternate for alteplase (ALT) for the treatment of suspect ischemic stroke. The purpose of this poster is to demonstrate the effectiveness of a regional initiative in the transition to the use of TNK over ALT to improve door-in-door-out (DIDO) times. Methods: CSC leadership held meetings and educational sessions with key stakeholders from referring hospitals across the region to discuss the feasibility and advantages of transitioning to TNK for stroke treatment. A TNK toolkit was provided which included dosing and safety information, sample order sets, cost-effectiveness, and consent information. DIDO times of hospitals using TNK were compared to those hospitals using alteplase over an 8-month period. Results: There were 37 patients included in the analysis, with 21 receiving ALT and 16 receiving TNK over the study period. Median DIDO times for ALT patients were 195.5 minutes while median DIDO times for TNK patients were 178.5 minutes. There were no major complications noted. Conclusions: DIDO times for TNK-treated patients appear to be less than those treated with ALT. As more regional hospitals begin to use TNK for suspected stroke, continued monitoring of DIDO times will be required. Additional analysis of DIDO data from transferring hospitals transitioned to TNK is needed. Regional change in stroke systems of care impacting multiple hospitals across a wide geographic area is feasible and impacts the efficiency of treatment. Additional study is needed to determine if the effect is sustainable and results in improved outcomes.