Abstract T P196: Tissue Plasminogen Activator is Safe When Administered by Neurovascular Fellows via Telemedicine
Objective: Telemedicine (TM) has increased the use of intravenous (IV) tissue plasminogen activator (tPA) for management of acute ischemic stroke. Despite its known safety in guiding tPA treatment, TM has not been formally embedded into stroke fellowship training. We compared the safety of tPA administration via TM consultation by neurovascular fellows (NVFs) versus neurovascular attendings (NVAs).
Methods: In a retrospective chart review from 4/12 to 4/13, we identified 137 patients who were given IV-tPA at the advice of a NVA or NVF in our 14 spoke TM network. We abstracted baseline characteristics and clinical variables. We compared outcomes in patients treated by NVFs versus NVAs. Logistic regression was performed to compare rates of symptomatic intracranial hemorrhage (sICH), neurological worsening (an increase in NIHSS of ≥2 regardless of etiology), angioedema, and death. Median time between symptom onset and tPA administration was also compared between NVFs and NVAs.
Results: Table 1 illustrates baseline characteristics. Of 137 consecutive patients given IV-tPA via TM, fellows treated 48 patients (35%). The sICH rates between patients treated by NVFs and those by NVAs were not significantly different (2.1% vs 1.1%, p=1.00) (Table 2). Neurologic worsening occurred in 6.3% of cases treated by NVFs and 6.7% by NVAs (p=1.00). The rates of angioedema between patients treated by NVFs and those by NVAs were not significantly different (0% vs 1.1%) (Table 2). While death rate was higher in patients treated by NVAs (4.5% vs 0%), this increment was not significant (Table 2). The median minutes between symptom onset and tPA administration was 10.5 more for NVFs than NVAs (143 vs 132.5, p<0.05) (Table 2).
Conclusion: Although NVFs took more time to give tPA compared to NVAs, administration of IV tPA via telemedicine was safe when advised by NVFs compared with NVAs. This finding supports the feasibility of formally integrating telemedicine exposure into fellowship training.
Author Disclosures: A. Jagolino: None. K. Gildersleeve: None. H. Indupuru: None. C. Cai: None. M. Rahbar: None. A. Sarraj: None. S.I. Savitz: None. T. Wu: Speakers' Bureau; Modest; Genentech.
- © 2015 by American Heart Association, Inc.