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Thrombolytic Refusal Over Telestroke.

Alicia Zha1, Adriana Rosero1, Rene Malazarte1

  • 1Institute for Stroke and Cerebrovascular Disease (AZ, AR, LZ, TDC, SS, TCW, AJ-C), The University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX; and Department of Neurology (AZ, AR, RM, SB, CA, LZ, MJ, AT, TDC, SS, TCW, AJ-C), The University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX.

Neurology. Clinical Practice
|September 6, 2021
PubMed
Summary
This summary is machine-generated.

Tissue plasminogen activator (tPA) refusal in telestroke (TS) care occurred in 8% of eligible acute ischemic stroke (AIS) patients. Refusal rates were similar to non-TS settings, with no difference in outcomes between those who received tPA and those who refused.

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Health Services Research

Background:

  • Tissue plasminogen activator (tPA) refusal rates for acute ischemic stroke (AIS) range from 4%-6% in emergency departments.
  • Telestroke (TS) services have improved tPA accessibility but introduced communication challenges impacting informed consent.
  • This study investigated tPA refusal incidence and reasons within a TS network.

Purpose of the Study:

  • To determine the rate of tPA refusal in a telestroke network for AIS patients.
  • To identify patient characteristics associated with tPA refusal.
  • To understand the primary reasons for tPA refusal in the TS setting.

Main Methods:

  • Analysis of the Lone Star Stroke Consortium Telestroke Registry (September 2015 - December 2018).
  • Inclusion of AIS patients eligible for tPA within 4.5 hours of symptom onset.
  • Comparison of baseline characteristics and clinical outcomes between tPA acceptors and refusers.

Main Results:

  • 8% of 1,242 eligible AIS patients refused tPA.
  • Female, non-Hispanic Black patients, and those with prior stroke history were more likely to refuse tPA.
  • Reasons for refusal included mild/improving symptoms and concerns about side effects; no significant difference in good outcomes (90-day mRS 0-2) was observed between groups.

Conclusions:

  • tPA refusal rates in telestroke are comparable to traditional settings.
  • No significant difference in clinical outcomes exists between AIS patients who accept or refuse tPA.
  • Further research into sex and racial disparities in tPA refusal is needed to ensure equitable treatment decisions.