Drip and Ship Thrombolytic Therapy for Acute Ischemic StrokeUse, Temporal Trends, and Outcomes1. Go, Shiela May N.BSN 4-AGo, Shiela May N.BSN 4-A2. Kevin N. Sheth, MD,3. Eric E. Smith, MD, MPH,4. Maria V. Grau-Sepulveda, MD, MPH,5. Dawn Kleindorfer, MD,6. Gregg C. Fonarow, MDand7. Lee H. Schwamm, MD

+Author AffiliationsAbstractBackground and PurposeInterhospital transfer after use of intravenous tissue-type plasminogen activator (tPA) in acute stroke (drip and ship) is increasingly frequent. Small studies have suggested that drip and ship tPA is safe and increases rates of tPA use; however, little is known about real-world practice patterns. We sought to evaluate temporal trends in drip and ship tPA use and to compare the patient and hospital characteristics with that of conventional (front door) thrombolysis.MethodsWe analyzed data from 44667 patients with ischemic stroke treated with intravenous tPA 3 hours of symptom onset in the Get With The Guidelines-Stroke program from April 2003 to October 2010 in 1440 hospitals. The main outcomes were the frequency of drip and ship tPA use over time, the characteristics of patients treated, and in-hospital outcomes, treatments, and complications.ResultsAmong 44667 patients treated with tPA, the drip and ship method was a common method (n=10475; 23.5%), the use of which increased in parallel with the traditional tPA method over time. Patients treated by the drip and ship method differed significantly from front-door patients, with lower National Institutes of Health Stroke Scale scores when recorded (n=35467). Crude in-hospital mortality (10.9%) and symptomatic intracranial hemorrhage (5.7%) in patients treated by the drip and ship method were slightly higher compared with those in front-door patients, and these differences persisted after risk adjustment.ConclusionsDrip and ship tPA is common, used in 1 in 4 patients treated with tPA in the United States. Modest differences in mortality and symptomatic intracranial hemorrhage may be because of patient selection bias, post-tPA care differences, or unmeasured confounding. The drip and ship paradigm may facilitate widespread tPA use in patients with acute stroke.Key Words: emergency medicine stroke tissue-type plasminogen activator

ReceivedSeptember 19, 2014. Revision receivedNovember 17, 2014. AcceptedDecember 2, 2014. 2015 American Heart Association, Inc.

http://stroke.ahajournals.org/content/early/2015/02/10/STROKEAHA.114.007506

Stem cell recruitment factor boosts ventricular remodelling in heart failureDr. M. Penn(Ohio, US)Tuesday 26 May 2015A factor that promotes tissue repair via increased cell survival, endogenous bone marrow-derived and cardiac stem cell recruitment, and vasculogenesis improves remodelling in heart failure patients, offering hope of a novel treatment in more severe cases, delegates heard today. In a phase II, double-blind, randomised placebo-controlled trial presented during a Late Breaking Trials session, Marc Penn, from Summa Health System, Akron, Ohio, USA, showed that plasmid stromal cell-derived factor-1 (pSDF-1) leads to sustained improvement in left ventricular remodelling, particularly in patients with a low ejection fraction. Dr Penn and colleagues began working on SDF-1 after hypothesising that stem-cell-based repair of injured tissue is a natural process but clinically inefficient, not because we lack stem cells but because the molecular signals that orchestrate how stem cells heal us are dysregulated, he said. Speaking to Heart Failure Congress News, he added: We made the observation early on that stem cells put in the blood stream of an animal having a heart attack go to the heart. Stem cells put in the bloodstream of animals with heart failure do not. Dr Penn and colleagues therefore looked for factors that encourage stem cells to go to newly injured tissues, settling on SDF-1 in late 2000/early 2001. Since then, they have determining whether reestablishment of SDF-1 expression in heart failure leads to clinical improvement.For the current trial, the researchers randomised 93 ischaemic heart failure patients on stable medical therapy and a left ventricular ejection fraction (LEVF) 40% to 15 mg or 30 mg plasmid SDF-1 or placebo via endomycardial injections. There were no serious adverse events. Overall, there was a nonsignificant trend towards an improvement in LVEF and left ventricular end-systolic volume (LVESV) with SDF-1 (p=0.44).Further analysis revealed that, for patients in the lowest LVEF tertitle (