"A Single Center Retrospective Analysis of Door-to-Needle Times of Anti" by Mauricio Concha, Tonya King et al.
 

A Single Center Retrospective Analysis of Door-to-Needle Times of Anticoagulation Reversal Agents in Intracranial Hemorrhage

Document Type

Article

Publication Date

5-2-2024

Publication Title

Journal of Neurological Disorders & Stroke

Abstract

Objective: Anticoagulant associated intracranial hemorrhage (AA-ICrH) accounts for 10-25% of all intracranial hemorrhages. Being on anticoagulation at the time of the event of hemorrhage more than doubles the risk of hematoma expansion and mortality. Despite the rapid onset of action of the new anticoagulation reversal agents no guidelines for target times to treatment have been established. We evaluated anticoagulation reversal treatment times among patients with AA-ICrH presenting to a single large community hospital with institutional target times established in 2018.

Methods: Retrospective chart review was performed for all AA-ICrH treated with reversal agents in Sarasota Memorial Hospital Comprehensive Stroke Center, Sarasota, Florida, between 2018-2021. Clinical and non-clinical variables were collected. Predictors with p<0.20 in the univariate analysis were investigated further in a multivariable model.

Results: We identified 164 patients, 60 % male, 94% Caucasian. FXa inhibitors were used among 67%, warfarin 29% and dabigatran 4%. Half the cohort was treated with andexanet, 46% with PCC and 4% with idarucizumab. Most arrived via emergency medical services (EMS), 74%, transfers from other facilities, 11%, and walk-ins, 15%. Overall, 70% arrived <6 hours from symptom onset, 54% and 20% were treated under trauma alert (TA) and stroke alert (SA) protocols, respectively. Overall median [IQR] door-to-needle (DTN) and CT -to-needle (CTN) times (minutes) were 102 [69-181] and 75 [55-112], respectively. However, DTN was faster for SA, 65 [52-99], followed by TA 96 [70-160], p<0.001. DTN ≤90 minutes was seen in 42% of all cohort but in 73% of SA and 48% of TA. CTN ≤60 minutes was achieved in 36% overall, but in 62% of SA and 36% of TA. SA and TA protocols (p<0.001), and arrival by EMS (p=0.02) were independent predictors of faster DTN times.

Conclusions: Similar to ischemic strokes, treatment under SA or TA protocols and arrival by EMS were associated with significantly faster DTN times for anticoagulation reversal therapies in patients presenting with AA-ICrH. Our institution’s proposed target times for DTN ≤90 and CTN ≤60 minutes for >75% of all treated AA-ICrH remained unmet during the study period. Increased awareness and tracking of DTN metric may help achieve timely anticoagulation reversal in AA-ICrH.

Volume

11

Issue

2

First Page

1220

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