Where Are Opportunities To Increase Intravenous Thrombolysis In Current Practice? (P7.126)

BACKGROUND: IV-tPA rates fluctuate depending upon location and definition, with large studies showing regional variation from 3% - 21%. To determine opportunities for improving intervention rates for acute ischemic stroke (AIS), it is important to know current thrombolysis rates as well as the theoretical maximum rate achievable within a given community. Understanding the discrepancy between current and potential intervention rates may aid in analyzing possible avenues for improvement. DESIGN/METHODS: Aggregate results from the “Get With The Guidelines” (GWTG) databases of the four primary stroke centers (PSC’s) in Monroe County, NY were analyzed from July 2011 to March 2013. Analysis was restricted to AIS patients presenting with NIHSS≠0 within 3.5 hours of stroke onset (i.e. permitting 蠅 1 hour for thrombolysis within the 4.5 hour window). We recorded whether or not patients received IV-tPA, and tracked their absolute versus relative contraindications as defined by AHA and ECASS-III criteria. RESULTS: There were 2742 patients presenting with AIS/TIA to the four PSC’s during the study. Of all patients presenting within 4.5 hours, 24.5% presented within 3.5 hours with NIHSS≠0, of whom 34.2% received IV-tPA. Reasons for not receiving IV-tPA were categorized as (a) having at least one absolute contraindication (23.3%), (b) having only relative contraindications (59.6%), or (c) no documented contraindication (17.1%). The two most frequent relative contraindications were “rapid improvement” and/or “low NIHSS”, affecting 64.0% patients. CONCLUSIONS: Excluding absolute and undocumented contraindications, patients arriving outside 3.5 hours, and patients with an initial NIHSS of 0, 73.4% of patients with stroke were eligible to receive IV-tPA before considering relative contraindications. Applying recent AHA guidelines promoting IV-tPA use in patients with rapidly improving symptoms and/or low NIHSS could have increased thrombolysis rates of 8.4% to a theoretical maximum of 14.9% in Monroe County. Analogous opportunities may exist for increasing thrombolysis rates across other communities. Disclosure: Dr. Koch has nothing to disclose. Dr. Kung has nothing to disclose. Dr. Damania has nothing to disclose. Dr. Jain has nothing to disclose. Dr. Jain has nothing to disclose. Dr. Benesch has received research support from AGA Medical. Dr. Jahromi has nothing to disclose.