Abstract TMP47: IMPROVING Time To Anti-Coagulation Reversal For Hemorrhagic Strokes
Dymm, B; Kolls, B; Ehrlich, M; Monk, L; Shah, S; Iversen, E; Roettig, ML; Xian, Y; Jollis, J; Granger, C; Graffagnino, C
Published in: Stroke
Oral anticoagulation (OAC) is a risk factor for intracerebral hemorrhage (ICH) which is an important source of disability and mortality. OAC-associated ICH (OAC-ICH) patients have worse outcomes as compared to ICH patients not on OAC, likely because of the associated larger stroke volumes, higher propensity to intraventricular hemorrhage, and a higher risk of rebleeding. Although current guidelines recommend that OAC should be reversed as quickly as possible, many health care systems have not developed a process for optimizing that aspect of care.
Through the IMPROVE Stroke Care Consortium, a group of nine Hub hospitals and their regional community hospitals, a systems of care improvement project was implemented. Performance reviews identified best practices which were disseminated throughout all centers. We compared the median door-to-reversal (DTR) time before and after an institutional campaign to speed the process with a target time of 60 minutes.
Over two years of the study, there were 6,699 ischemic strokes, 152 subarachnoid hemorrhages, and 889 intracranial hemorrhages. During that time, 36 hemorrhagic stroke patients received reversal agents emergently. The baseline median DTR time was 123 minutes (IQR 99, 361 minutes) for all comers. By the end of the program, the median DTR time had been reduced to 92.5 minutes (IQR 59, 163 minutes) which is a trend towards 59% reduction of DTR from baseline (p=0.08).
Utilizing an integrated stroke systems of care approach we were able to reduce DTR times for patients presenting with acute ICH and concurrent use of anticoagulants in spite of the lack of definitive guidelines as to how quickly reversing agents should be given.
