Clinical Risk Factors in Thrombolysis therapy: Telestroke Versus Nontelestroke

The objective of this study is to determine clinical risk factors associated with exclusion from thrombolysis in telestroke and nontelestroke settings. These risk factors may offer clues for optimization of thrombolysis therapy in acute ischemic stroke population.

Retrospective data of patients with acute ischemic stroke via telestroke and nontelestroke assessment were analyzed. Univariate analysis was used to compare the recombinant tissue plasminogen activator (rtPA) group and the no rtPA group. A stepwise binary logistic regression identified factors associated with inclusion and exclusion from rtPA in the total telestroke population and the subsets of the telestroke population.

Telestroke patients were more likely to be directly admitted rather than being initially evaluated in the emergency department (70.3% versus 9.9%) and were also substantially more likely to receive rtPA (89.5% versus 38.5%). In the nontelestroke group, patients with acute ischemic stroke were more likely to be excluded from rtPA if they possessed higher international normalized ratios (odds ratio [OR] = 4.978 [1.503-16.488]) or had a history of congestive heart failure (OR = 2.524 [1.213-5.252]), previous stroke (OR = 2.172 [1.286-3.667]), or renal dysfunction (OR = 4.204 [1.33-13.281]). The telestroke group only had 1 variable deemed statistically significant in its association with rtPA status. Patients who were directly admitted were less likely to be excluded from receipt of rtPA (OR = .322 [.112-0.927]).

Factors associated with exclusion from rtPA in the nontelestroke setting did not exclude patients with acute ischemic stroke from thrombolysis therapy in the telestroke setting. Telestroke may offer methods for optimization of the risk-benefit ratio of rtPA, equipping clinicians to efficiently make treatment decisions.