Impact of Direct Transfer to Angiography Suite on Treatment Time Metrics in Patients With Acute Intracerebral Hemorrhage

Abstract

Background: Shorter times to initiate antihypertensive and anticoagulation reversal treatments enhance their benefits in acute intracerebral hemorrhage (ICH). Improving workflows to optimize time performance metrics is strongly advocated. We aimed to evaluate the impact of direct transfer to angiography suite (DTAS) on time metrics for antihypertensive and anticoagulation reversal treatments in patients with stroke with suspected large vessel occlusion whose final diagnosis was ICH.

Methods: We conducted a single-center, retrospective, observational cohort study using prospectively collected data from patients with ICH <6 hours directly arriving at a Comprehensive Stroke Center in Barcelona, Spain, from March 1, 2016, to August 31, 2023. Patients suspected of acute stroke from large vessel occlusion (prehospital Rapid Arterial Occlusion Evaluation scale score >4 and in-hospital National Institutes of Health Stroke Scale score >10) followed either direct transfer to computed tomography (DTCT) or DTAS protocol based on angiosuite availability. We compared door-to-needle times for initiating antihypertensive (primary outcome) and anticoagulation reversal treatments between both workflows.

Results: Among 220 patients with ICH (mean age, 73.0±13.6 years; 131 [59.5%] male), 199 (90.5%) followed the DTCT protocol and 21 (9.5%) followed the DTAS protocol. Door-to-imaging time was shorter in the DTCT group than in the DTAS group (11 [7-17] versus 15 [12-20] minutes; P=0.013). Antihypertensive treatment was initiated in 168 (76.4%) patients, with the DTCT group having shorter door-to-needle times (20 [15-26] versus 30 [18-40] minutes; P=0.002). The anticoagulation reversal was administered to 34 (87.2%) of 39 anticoagulated patients, with the DTCT group achieving shorter door-to-needle times (28 [22-38] versus 58 [39-78] minutes; P=0.047). Time-to-event analysis showed that the DTCT group had a higher probability of initiating antihypertensive (P=0.001) and anticoagulation reversal (P=0.014) treatments sooner compared with the DTSA group.

Conclusions: Patients with ICH following the DTAS workflow, without tailored actions, present longer door-to-needle times to initiate antihypertensive and anticoagulation reversal treatments compared with those following the DTCT workflow protocol.

Keywords: antihypertensive agents; blood pressure; cerebral hemorrhage; stroke; tomography.