Dripped and Shipped: Quick Action May Save Stroke Patients

Tissue plasminogen activator administered early to ischemic stroke patients who are then transferred to another hospital could save lives

(RxWiki News) A technique called "drip and ship" could save stroke patients. And doctors may be using this technique more frequently.

A new study found that an increasing number of stroke patients were receiving a "drip" (intravenous administration) of a medication called tissue-plasminogen activator (tPA) before their transfer (the "ship") to a stroke center. tPA is time-sensitive and should be given within the first three hours of a stroke — and this study found that many doctors were acting that quickly.

“We have to understand geographic and community variation in usage of inter-hospital transfer of tPA patients, and why some communities may use it more than other communities," said lead study author Kevin N. Sheth, MD, chief of the Neurocritical Care and Emergency Neurology Division at Yale School of Medicine in New Haven, CT, in a press release. "Ultimately, the goal is to have any patient that presents to their initial hospital anywhere in the country be able to receive tPA.”

A stroke is a life-threatening emergency that requires immediate care. Brain damage can occur if the brain’s supply of oxygen is cut off for very long.

Strokes are typically caused by either a burst blood vessel that bleeds into the brain or by a blood clot in the brain. They are called hemorrhagic and ischemic strokes, respectively.

For ischemic strokes, tPA is often used to dissolve the clot and restore normal circulation.

Dr. Sheth and team studied data on nearly 45,000 patients who had received tPA within three hours or less of an ischemic stroke between 2003 and 2010. They found that 23.6 percent of these patients —around 1 in 4 — were treated with the drip and ship technique.

“One in four is a very good number, and while we don’t know the best target, there may be room for improvement,” Dr. Sheth said.

Many patients first present at a community hospital, so doctors should recognize the signs and start tPA as quickly as possible after diagnosing a thrombotic stroke, these researchers said.

Speaking about the number of study patients who received the drip and ship technique, Murray Flaster, MD, PhD, a Loyola University Medical Center neurologist who specializes in treating stroke patients, told dailyRx News that "Twenty-five percent is higher than I might have guessed, but it is not unreasonable. Drip-and-ship is a well-recognized protocol for cases in which the hospital that initiates treatment has limitations in specialists and procedures, so it transfers the patient to another hospital."

Stroke centers are more likely to be large academic centers so they can see more ischemic stroke cases and have the facilities to treat seriously ill patients. Many hospitals with stroke centers may also be certified by the Joint Commission, a national organization for hospital quality.

Dr. Sheth said that one surprise in this study was that patients who were transferred were also more likely to have bleeding inside the skull. This may be a side effect from tPA, but these researchers did not have data on whether the bleeding was from the tPA or some other problem.

“We don't know the initial stroke severity for these patients and it's unclear why some patients were chosen to be transferred to a stroke center and others were not, though it's possible the sicker patients were the ones who were transferred to another facility,” Dr. Sheth said.

This study was presented Feb. 11 at the American Stroke Association’s International Stroke Conference 2015. It was published simultaneously in the journal Stroke.

Dr. Sheth and team disclosed no funding sources or conflicts of interest.

Review Date: 
February 3, 2015