Abstract TP80: Pre-mixing tPA: Moving Past Gestalt

Introduction: Target:Stroke recommends pre-mixing intravenous tPA before brain imaging for high likelihood acute ischemic stroke (AIS) patients, allowing the drug to be available immediately after the decision to treat is made. However, premixing tPA is rarely practiced despite potential benefits of improving door-to-needle time. Hypothesis: We describe our experience developing criteria to eliminate avoidable wasting of the drug by identifying patients most likely to benefit from pre-mixed tPA and compare rates of wasted tPA before and after criteria development. We hypothesized this would result in a substantial reduction in wasted tPA. Methods: On 4/1/14, our Comprehensive Stroke Center instituted a series of interventions to reduce door-to-needle times, including pre-mixing tPA for AIS patients presenting within the tPA treatment window. Seven vials of pre-mixed tPA were wasted over the next five weeks, revealing the need for specific criteria to guide the medical decision to order tPA prior to brain ...