Abstract W P55: Practice Diversity Among US Neurologists with Respect to the 3 to 4.5-Hour Window for Acute Stroke Thrombolysis
BACKGROUND: In 2009, the AHA/ASA endorsed extending the Acute Stroke IV tPA treatment window to 4.5 hours. Four additional exclusionary criteria were advised for treating patients in this extended window. It is unknown how the practice of stroke care has evolved since then. We developed an online survey aimed to evaluate the current practice patterns of neurologists when treating patients in the 3 to 4.5 hour therapeutic window.
METHODS: We developed a survey utilizing SurveyMonkey.com. The survey included 6 questions, 1. Subspecialty, 2. Frequency of informed consent when giving IV tPA in the 3 to 4.5 hour window, 3-6. Frequency excluding patient's from treatment in the 3 to 4.5 hour window for any of the additional exclusionary criteria. Answer options for questions 2-6 included: always, often (>50% of the time), seldom(<50% of the time), and never. The publicly available AHA/ASA online member directory was utilized to identify physicians meeting criteria: Council: Stroke, Specialty: Neuro/Stroke, Country: USA. The electronic survey was sent by email to 1000 identified physicians.
RESULTS: 260 physicians responded, 230 completed the survey in its entirety and were included in our results. Subspecialties were: 83% vascular neurology, 13% general neurology, and 3% other neurology. Informed consent was always obtained by 33%, often by 22%, seldom by 16%, and never by 28%. Responses for specific exclusion criteria for the 3 to 4.5-hour window were as follows: 1) 34% always excluded patients age >80, 23% often, 29% seldom, and 13% never; 2) 31% always excluded patients with concomitant history of diabetes mellitus and stroke, 21% often, 27% seldom, and 22% never; 3) 28% always excluded patients on warfarin with normal INR, 12% often, 15% seldom, and 46% never; 4) 36% always excluded patients with NIHSS >25, 24% often, 28% seldom, and 12% never.
CONCLUSION: Among US neurologists who care for stroke patients, there is notable diversity in practice with respect to IV thrombolysis within the 3 to 4.5-hour window. This may depict disparities in individual interpretation and acknowledgement of the scientific data pertaining to the extended window. There is a tendency towards obtaining informed consent and adherence to all four exclusion criteria, but not universally.
Author Disclosures: S. Mutgi: None. N. Lafountain: None. N. Grose: None. M.T. Torbey: None. R. Behrouz: None.
- © 2015 by American Heart Association, Inc.