Man-Seok Park1, Ji Sung Lee2, Tai Hwan Park3, Yong-Jin Cho4, Keun-Sik Hong4, Jong-Moo Park5, Kyusik Kang5, Kyung Bok Lee6, Jae Guk Kim7, Soo Joo Lee7, Jun Lee8, Kang-Ho Choi1, Joon-Tae Kim1, Ki-Hyun Cho1, Mi Sun Oh9, Kyung-Ho Yu9, Byung-Chul Lee9, Jae-Kwan Cha10, Dae-Hyun Kim10, Hyun-Wook Nah10, Juneyoung Lee11, Dong-Eog Kim12, Wi-Sun Ryu12, Beom Joon Kim13, Moon-Ku Han13, Hee-Joon Bae13, Sook-Keun Song14, Jay Chol Choi15. 1. Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea. 2. Clinical Research Center, Asan Medical Center, Seoul, South Korea. 3. Department of Neurology, Seoul Medical Center, Seoul, South Korea. 4. Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South Korea. 5. Department of Neurology, Eulji General Hospital, Eulji University, Seoul, South Korea. 6. Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea. 7. Department of Neurology, Eulji University Hospital, Daejeon, South Korea. 8. Department of Neurology, Yeungnam University Hospital, Daegu, South Korea. 9. Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea. 10. Department of Neurology, Dong-A University College of Medicine, Busan, South Korea. 11. Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea. 12. Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea. 13. Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea. 14. Department of Neurology, Jeju National University, Jeju, South Korea. 15. Department of Neurology, Jeju National University, Jeju, South Korea. Electronic address: jaychoi@jejunu.ac.kr.
Abstract
BACKGROUND: Data on the drip-and-ship paradigm in Korea are limited. The present study aimed to evaluate the use of the drip-and-ship paradigm and the time delays and outcomes associated with the paradigm in Korea. METHODS: We used data from the Clinical Research Center for Stroke-5 registry between January 2011 and March 2014. Among patients treated with tissue-type plasminogen activator (tPA), the use of the drip-and-ship paradigm was evaluated, and time delays and functional outcomes at 3 months were compared between patients treated with the paradigm and those treated directly at visits. RESULTS: Among 1843 patients who met the eligibility criteria, 244 patients (13.2%) were treated with the drip-and-ship paradigm. Subsequent endovascular recanalization therapy was used in 509 patients (27.6%). The median time from symptom onset to groin puncture was greater in patients treated with the paradigm than in those treated directly at visits (305 versus 200 minutes, P < .001). In multivariate analysis, the risks of unfavorable functional outcomes and symptomatic intracranial hemorrhage were higher inpatients treated with the paradigm than in those directly treated at visits (odds ratio [OR] 2.15; 95% confidence interval [CI], 1.50-3.08; P < .001 and OR 1.78; 95% CI, 1.02-3.12; P = .041, respectively). CONCLUSIONS: In Korea, the drip-and-ship paradigm was used in less than 15% of all patients treated with tPA. The use of the paradigm might cause an increase in the onset-to-groin puncture time. Additionally, clinical outcomes might be worse in patients treated with the paradigm than in those treated directly at visits.
BACKGROUND: Data on the drip-and-ship paradigm in Korea are limited. The present study aimed to evaluate the use of the drip-and-ship paradigm and the time delays and outcomes associated with the paradigm in Korea. METHODS: We used data from the Clinical Research Center for Stroke-5 registry between January 2011 and March 2014. Among patients treated with tissue-type plasminogen activator (tPA), the use of the drip-and-ship paradigm was evaluated, and time delays and functional outcomes at 3 months were compared between patients treated with the paradigm and those treated directly at visits. RESULTS: Among 1843 patients who met the eligibility criteria, 244 patients (13.2%) were treated with the drip-and-ship paradigm. Subsequent endovascular recanalization therapy was used in 509 patients (27.6%). The median time from symptom onset to groin puncture was greater in patients treated with the paradigm than in those treated directly at visits (305 versus 200 minutes, P < .001). In multivariate analysis, the risks of unfavorable functional outcomes and symptomatic intracranial hemorrhage were higher inpatients treated with the paradigm than in those directly treated at visits (odds ratio [OR] 2.15; 95% confidence interval [CI], 1.50-3.08; P < .001 and OR 1.78; 95% CI, 1.02-3.12; P = .041, respectively). CONCLUSIONS: In Korea, the drip-and-ship paradigm was used in less than 15% of all patients treated with tPA. The use of the paradigm might cause an increase in the onset-to-groin puncture time. Additionally, clinical outcomes might be worse in patients treated with the paradigm than in those treated directly at visits.
Authors: Jay Chol Choi; Joong Goo Kim; Chul Hoo Kang; Hee Joon Bae; Jihoon Kang; Soo Joo Lee; Jong Moo Park; Tai Hwan Park; Yong Jin Cho; Kyung Bok Lee; Jun Lee; Dong Eog Kim; Jae Kwan Cha; Joon Tae Kim; Byung Chul Lee; Ji Sung Lee; Anthony S Kim Journal: J Korean Med Sci Date: 2021-03-22 Impact factor: 2.153