Clinical Edge

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Treating Stroke Patients with tPA via Telemedicine

Stroke; ePub 2019 Mar 11; Wysocki, et al

There were no differences in measured outcomes between leaving tissue-type plasminogen activator (tPA)-treated ischemic stroke patients at a presenting (spoke) hospital (drip-and-stay) or transferring patients to a central treating (hub) hospital (drip-and-ship). This according to a recent study that compared outcomes between drip-and-ship and drip-and-stay patients treated with tPA via telemedicine. Researchers retrospectively identified patients treated with tPA at 17 spoke hospitals between September 2015 and December 2016. Demographic, clinical, and outcome data were obtained from a prospective telemedicine registry. They found:

  • Among 430 tPA-treated patients, 232 (53.9%) were transferred to the hub after treatment.
  • The median arrival National Institutes of Health Stroke Scale score was higher for drip-and-ship (10; interquartile range, 5–18) compared with drip-and-stay patients (6; interquartile range, 4–10).
  • Unadjusted length of stay (LOS) was longer in drip-and-stay patients (incidence rate ratio, 0.82).
  • There were no significant differences in adjusted LOS, hospital mortality, or discharge disposition.


Wysocki NA, Bambhroliya A, Ankrom C, et al. Outcomes among patients with ischemic stroke treated with intravenous tPA (tissue-type plasminogen activator) via telemedicine.

Is the drip-and-stay model safe? [Published online ahead of print March 11, 2019]. Stroke. doi:10.1161/STROKEAHA.118.024703.