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J Stroke Cerebrovasc Dis. 2016 Nov;25(11):2678-2687. doi: 10.1016/j.jstrokecerebrovasdis.2016.07.015. Epub 2016 Jul 29.

Characteristics of the Drip-and-Ship Paradigm for Patients with Acute Ischemic Stroke in South Korea.

Author information

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.

KEYWORDS:

Acute ischemic stroke; drip-and-ship; endovascular treatment; outcome assessment

[Indexed for MEDLINE]

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