Introduction: As acute ischemic stroke (AIS) management via Telestroke (TS) increases and the inclusion criteria for tPA expands, it is crucial to evaluate the long term outcomes of patients treated with off-label tPA. Off-label tPA, was defined as treating patients with at least one exclusion criteria, which is either being outside the time window (more than 4.5 hours after last known well time) or having relative contraindications per the AHA 2013 scientific statement for the early management of patients with AIS.
Objective: To compare outcomes of AIS patients who were treated with off-label tPA to those who were treated with on-label tPA via TS.
Methods: From 9/2015-12/2016, we identified 424 suspected AIS patients who were treated with tPA in our TS registry of patients who were evaluated by video consultation at one of 17 spoke hospitals. We compared the baseline characteristics and the outcomes of patients who received off-label vs on-label tPA.
Results: Of 424 suspected AIS patients who were treated with tPA, 86 (20.3%) received off-label tPA. Of 86 patients who received off-label tPA, 60 (69.8%) had relative contraindications and 35 (40.7%) were outside the time window. There was no significant difference between age, gender and race/ethnicity in receiving off-label tPA. Patients with more severe strokes were more likely to receive off-label tPA (p=0.023). The outcome measures including tPA complications, discharge disposition, length of stay and 90-day mRS were not significantly different between off-label and on-label groups after controlling for baseline characteristics.
Conclusion: Our study suggests that patients evaluated via telestroke with more severe stroke were more likely to receive off-label tPA. There was no significant difference between outcome measures of the off-label and on-label group suggesting that the off-label group does not have more tPA complications or worse outcome.