Intro: Many strategies have been suggested to increase the propotion of patients with an IV tPA door to needle time (DTN) within 60 minutes of ED arrival (DTN≤60), which ahs been shown to improve outcomes. We sought to investigate the effect of early tPA dispensing on DTN≤60.
Methods: Using our local GWTG database and pharmacy dispensing logs from the automated pharmacy cabinet (Omnicell), we identified all patients administered IV tPA from 4/07-6/14. We defined an early tPA treatment decision as the dispensing of tPA from the Omnicell before the CT scan was performed.
Results: Patients achieving a DTN≤60 were less likely to be white and more likely to present with weakness compared to those with DTN>60. They had shorter door-to-tPA dispensed (DTD) and door-to-CT (DTCT) times (Table). On multivariable analysis, white race (aOR=0.19, p=0.05), DTD (aOR=0.97 per min, p=0.001) and DTCT (aOR=0.93 per min, p<0.001) remained significantly associated with DTN<60. DTD time was highly correlated with the DTN time (R2=0.44, p60 (16.6+9.5 vs. 37.3+24.5 min, p<0.001). An early treatment decision was associated with a shorter absolute DTN time (36 min (27,52) vs. 50 min (37.5,66), p-value<0.001) and remained significant in multivariable testing (aOR 7.43(0.80,14.06); p=0.03) with DTD time (a0.80 per min (0.65,0.93); p<0.001).
Conclusion: Our study supports the Target Stroke best practice of premixing tPA in high likelihood tPA candidates, and confirms that early determination of tPA eligibiltiy can be a successful strategy in reducing DTN times.