Improve time to anti-coagulation reversal for hemorrhagic strokes

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-10-15 DOI:10.1016/j.jstrokecerebrovasdis.2024.108090

Braydon Dymm MD , Carmelo Graffagnino MD , Gabriel Torrealba Acosta MD , Matthew E Ehrlich MD, MPH , Lisa Monk MSN , Shreyansh Shah MBBS , Edwin Iversen PhD , Brad J Kolls MD, PhD , IMPROVE stroke consortium

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引用次数: 0

Abstract

Background

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 quickly, many health care systems have not developed a process for optimizing that aspect of care.

Methods

Through the IMPROVE Stroke Care Consortium, a group of nine Hub hospitals and their 57 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 min.

Results

Over two years of the study, there were 6,699 ischemic strokes, 152 subarachnoid hemorrhages, and 889 intracerebral hemorrhages. During that time, 73 ICH patients received reversal agents emergently. The overall baseline median DTR time was 123 min (IQR 99, 361 minutes). By the end of the program, the median DTR time had trended down to 84 min (IQR 58.5, 151 min) which is a 31.7 % reduction of DTR from baseline, though times remained somewhat variable (p=0.08).

Conclusions

An integrated stroke systems of care approach was associated with a reduction in DTR times for patients presenting with acute ICH and concurrent use of anticoagulants despite lack of definitive guidelines around targets for OAC reversal times or operational guidance on protocols and agents.

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缩短出血性脑卒中患者的抗凝血逆转时间。

背景：口服抗凝药（OAC）是脑内出血（ICH）的一个危险因素，是导致残疾和死亡的一个重要原因。与未服用 OAC 的 ICH 患者相比，OAC 相关 ICH（OAC-ICH）患者的预后较差，这可能是因为相关的卒中体积较大、脑室内出血倾向较高以及再出血风险较高。尽管目前的指南建议应迅速逆转 OAC，但许多医疗系统尚未制定出优化这方面护理的流程：通过 IMPROVE 中风护理联盟（由 9 家枢纽医院及其 57 家地区社区医院组成），实施了一项护理系统改进项目。绩效评估确定了最佳实践，并在所有中心推广。我们比较了以 60 分钟为目标加快流程的机构运动前后的门到转运（DTR）时间中位数：在两年的研究中，共发生了 6699 例缺血性脑卒中、152 例蛛网膜下腔出血和 889 例脑出血。在此期间，73 名 ICH 患者紧急接受了逆转剂治疗。总体基线中位 DTR 时间为 123 分钟（IQR 99 - 361 分钟）。计划结束时，中位 DTR 时间已降至 84 分钟（IQR 58.5 - 151 分钟），与基线相比减少了 31.7%，但时间仍存在一定的差异（P=0.08）：结论：尽管缺乏有关 OAC 逆转时间目标的明确指南或有关方案和药物的操作指南，但综合卒中系统护理方法可缩短急性 ICH 患者的 DTR 时间，并可同时使用抗凝药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.