2020
Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries
Man S, Xian Y, Holmes D, Matsouaka R, Saver J, Smith E, Bhatt D, Schwamm L, Fonarow G. Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries. Circulation Cardiovascular Quality And Outcomes 2020, 13: e007150. PMID: 33302714, DOI: 10.1161/circoutcomes.120.007150.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overDatabases, FactualFemaleFibrinolytic AgentsHumansInfusions, IntravenousInsurance BenefitsIschemic StrokeMaleMedicarePatient ReadmissionQuality ImprovementQuality Indicators, Health CareRetrospective StudiesRisk AssessmentRisk FactorsThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsAcute ischemic strokeIschemic strokeNeedle timeIntravenous thrombolysisCardiovascular readmissionCause mortalityThrombolytic treatmentThrombolytic therapyMedicare beneficiariesGuidelines-Stroke hospitalsIntravenous thrombolytic therapyIntravenous thrombolytic treatmentOne-year outcomesProportion of patientsProportional hazards analysisAmerican Heart AssociationQuality InitiativeCause readmissionMedian doorHospital clusteringMedian ageHeart AssociationHospital characteristicsReadmissionImproved doorAssociation Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke
Man S, Xian Y, Holmes D, Matsouaka R, Saver J, Smith E, Bhatt D, Schwamm L, Fonarow G. Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke. JAMA 2020, 323: 2170-2184. PMID: 32484532, PMCID: PMC7267850, DOI: 10.1001/jama.2020.5697.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorAcute ischemic strokeTissue plasminogen activatorCause mortalityNeedle timeCause readmissionIschemic strokeLong-term outcomesShorter doorBetter long-term outcomesImproved long-term outcomesPlasminogen activatorRetrospective cohort studyGood functional outcomeGuidelines-StrokeCohort studyHospital arrivalHospital dischargeMedian doorEarly administrationMedian agePrimary outcomeThrombolytic therapyFunctional outcomeReadmissionSafety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months
Shah S, Liang L, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Feng W, Peterson E, Xian Y. Safety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006031. PMID: 31903770, DOI: 10.1161/circoutcomes.119.006031.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedAged, 80 and overBrain IschemiaDatabases, FactualFemaleFibrinolytic AgentsHospital MortalityHumansInfusions, IntravenousIntracranial HemorrhagesMaleMedicareRecurrenceRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic stroke patientsPrior ischemic strokeSymptomatic intracranial hemorrhageIschemic stroke patientsPrior strokeHospital mortalityIntravenous tPAIschemic strokeIntracranial hemorrhageStroke patientsGuidelines-Stroke hospitalsHigher stroke severityGood functional outcomeHistory of strokeRetrospective observational studyYears of ageCardiovascular comorbiditiesStroke providersStroke severityUnadjusted riskFunctional outcomeHigh prevalenceObservational studyMedicare claimsElevated risk
2017
Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice
Xian Y, Xu H, Lytle B, Blevins J, Peterson E, Hernandez A, Smith E, Saver J, Messé S, Paulsen M, Suter R, Reeves M, Jauch E, Schwamm L, Fonarow G. Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003227. PMID: 28096207, DOI: 10.1161/circoutcomes.116.003227.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaCross-Sectional StudiesFibrinolytic AgentsGuideline AdherenceHealth Care SurveysHumansInfusions, IntravenousPractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeConceptsNational quality improvement initiativeGuidelines-Stroke hospitalsAcute ischemic strokeDTN timeIntravenous tPAIschemic strokeNeedle timeTissue-type plasminogen activator administrationMedian DTN timeIschemic stroke patientsEmergency medical services (EMS) providersQuality improvement initiativesTissue-type plasminogen activatorHospital arrivalSymptom onsetStroke patientsMedical service providersClinical practiceHospitalPatientsMost hospitalsPlasminogen activatorPhase IStrokeImprovement initiatives
2015
Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke
Sheth KN, Smith EE, Grau-Sepulveda MV, Kleindorfer D, Fonarow GC, Schwamm LH. Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke. Stroke 2015, 46: 732-739. PMID: 25672784, DOI: 10.1161/strokeaha.114.007506.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorSymptomatic intracranial hemorrhageTPA useAcute strokeIschemic strokeIntracranial hemorrhageHealth Stroke Scale scoreReal-world practice patternsGuidelines-Stroke programStroke Scale scoreAcute ischemic strokeCharacteristics of patientsLower National InstitutesPatient selection biasConventional thrombolysisHospital mortalityHospital outcomesSymptom onsetInterhospital transferThrombolytic therapyHospital characteristicsPractice patternsShip paradigmMAIN OUTCOME
2014
Development and Initial Testing of the Stroke Rapid-Treatment Readiness Tool
Olson D, Cox M, Constable M, Britz G, Lin C, Zimmer L, Fonarow G, Schwamm L, Peterson E. Development and Initial Testing of the Stroke Rapid-Treatment Readiness Tool. Journal Of Neuroscience Nursing 2014, 46: 267-273. PMID: 25099063, PMCID: PMC4165480, DOI: 10.1097/jnn.0000000000000082.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorTissue plasminogen activatorPlasminogen activatorQuality Improvement ProgramGuidelines-StrokeEligible patientsHospital arrivalIschemic strokeNeedle timeHealth systemU.S. hospitalsHospitalReadiness ToolInitial testingLikert scale surveyPatientsActivatorImprovement programsStrokeAdministration
2013
Characteristics and Outcomes Among Patients Transferred to a Regional Comprehensive Stroke Center for Tertiary Care
Ali S, Singhal A, Viswanathan A, Rost N, Schwamm L. Characteristics and Outcomes Among Patients Transferred to a Regional Comprehensive Stroke Center for Tertiary Care. Stroke 2013, 44: 3148-3153. PMID: 24021682, DOI: 10.1161/strokeaha.113.002493.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIntravenous tissue plasminogen activatorInitial National InstitutesComprehensive stroke centerHospital mortalityIschemic strokeTissue plasminogen activatorStroke centersStroke careDoor patientsHealth Stroke Scale scoreMedian initial National InstitutesAcute ischemic stroke carePlasminogen activatorLonger hospital lengthStroke care centerHealth Stroke ScaleStroke Scale scoreCoronary artery diseaseIschemic stroke careAcute care hospitalsNational InstituteHospital lengthSevere strokeStroke RegistryTime to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke
Saver J, Fonarow G, Smith E, Reeves M, Grau-Sepulveda M, Pan W, Olson D, Hernandez A, Peterson E, Schwamm L. Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke. JAMA 2013, 309: 2480-2488. PMID: 23780461, DOI: 10.1001/jama.2013.6959.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeSymptomatic intracranial hemorrhageTissue-type plasminogen activatorIschemic strokeIntracranial hemorrhageIndependent ambulationHospital mortalityThrombolytic treatmentClinical practiceIntravenous tissue-type plasminogen activatorMedian pretreatment National InstitutesIntravenous tissue plasminogen activatorPlasminogen activatorGreater stroke severityGuidelines-Stroke programPretreatment National InstitutesHealth Stroke ScaleUS clinical practiceRandomized clinical trialsTissue plasminogen activatorHospital presentationShorter OTTAmbulatory statusHospital deathStroke Scale
2012
Risks of Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Receiving Warfarin and Treated With Intravenous Tissue Plasminogen Activator
Xian Y, Liang L, Smith E, Schwamm L, Reeves M, Olson D, Hernandez A, Fonarow G, Peterson E. Risks of Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Receiving Warfarin and Treated With Intravenous Tissue Plasminogen Activator. JAMA 2012, 307: 2600-2608. PMID: 22735429, DOI: 10.1001/jama.2012.6756.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorInternational normalized ratioSymptomatic intracranial hemorrhageTissue plasminogen activatorSerious systemic hemorrhageIschemic strokeIntracranial hemorrhageSICH riskHospital mortalitySystemic hemorrhagePlasminogen activatorBaseline clinical factorsChronic warfarin therapyGuidelines-Stroke registrySecondary end pointsDegree of anticoagulationAmerican Heart AssociationRegistry hospitalsSICH rateSevere strokeWarfarin therapyClinical factorsComorbid conditionsHeart AssociationNormalized ratioUse of Tissue-Type Plasminogen Activator Before and After Publication of the European Cooperative Acute Stroke Study III in Get With The Guidelines-Stroke
Messé S, Fonarow G, Smith E, Kaltenbach L, Olson D, Kasner S, Schwamm L. Use of Tissue-Type Plasminogen Activator Before and After Publication of the European Cooperative Acute Stroke Study III in Get With The Guidelines-Stroke. Circulation Cardiovascular Quality And Outcomes 2012, 5: 321-326. PMID: 22550132, DOI: 10.1161/circoutcomes.111.964064.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overEuropeFemaleFibrinolytic AgentsGuideline AdherenceHumansInfusions, IntravenousLinear ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioOutcome and Process Assessment, Health CarePractice Guidelines as TopicStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic strokeEuropean Cooperative Acute Stroke Study (ECASS) IIIECASS IIITreatment of patientsUse of tPAEligible patientsHours of AISProportion of patientsStudy IIITissue-type plasminogen activatorGuidelines-StrokeIschemic strokeMedian doorNeedle timePatientsClinical practiceTreatment ratesPlasminogen activatorSignificant increaseHoursLater time windowAdverse affectsTPATreatmentProportionPredictors of Increased Intravenous Tissue Plasminogen Activator Use Among Hospitals Participating in the Massachusetts Primary Stroke Service Program
Rost N, Smith E, Pervez M, Mello P, Dreyer P, Schwamm L. Predictors of Increased Intravenous Tissue Plasminogen Activator Use Among Hospitals Participating in the Massachusetts Primary Stroke Service Program. Circulation Cardiovascular Quality And Outcomes 2012, 5: 314-320. PMID: 22534407, PMCID: PMC3361890, DOI: 10.1161/circoutcomes.111.962829.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overEmergency Service, HospitalFemaleFibrinolytic AgentsHealthcare DisparitiesHumansInfusions, IntravenousLinear ModelsLogistic ModelsMaleMassachusettsMiddle AgedMultivariate AnalysisOdds RatioPatient SelectionPractice Guidelines as TopicQuality ImprovementRegional Medical ProgramsRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeConceptsIntravenous tissue plasminogen activator useTissue plasminogen activator useAcute ischemic strokeTPA useIschemic strokeOlder acute ischemic stroke patientsAcute ischemic stroke patientsGuidelines-Stroke programStroke center designationIschemic stroke patientsRate of thrombolysisQuality improvement initiativesEmergency medical servicesStroke onsetSymptom onsetStroke patientsTreatment disparitiesCenter designationPatientsHospitalMassachusetts DepartmentImprovement initiativesMedical servicesOverall rateFurther studiesInfarct Volume Is a Pivotal Biomarker After Intra-Arterial Stroke Therapy
Yoo A, Chaudhry Z, Nogueira R, Lev M, Schaefer P, Schwamm L, Hirsch J, González R. Infarct Volume Is a Pivotal Biomarker After Intra-Arterial Stroke Therapy. Stroke 2012, 43: 1323-1330. PMID: 22426317, DOI: 10.1161/strokeaha.111.639401.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overBiomarkersBrain InfarctionCohort StudiesDatabases, FactualFemaleFibrinolytic AgentsHumansInfusions, IntravenousMagnetic Resonance ImagingMaleMiddle AgedNeuroimagingPredictive Value of TestsProspective StudiesRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTomography, X-Ray ComputedTreatment OutcomeConceptsFinal infarct volumeIntra-arterial therapyAcute ischemic strokeInfarct volumeFunctional outcomeBetter outcomesIschemic strokePoor outcomeAnterior circulation acute ischemic strokeScale scoreHealth Stroke Scale scoreMedian admission National InstitutesMedian final infarct volumesLong-term functional outcomeIntra-arterial stroke therapyAdmission National InstitutesProximal artery occlusionStroke Scale scoreOnly independent predictorRankin Scale scoreArtery occlusionProspective cohortRankin ScaleIndependent predictorsClinical outcomes
2011
Prestroke Dementia is Associated With Poor Outcomes After Reperfusion Therapy Among Elderly Stroke Patients
Busl K, Nogueira R, Yoo A, Hirsch J, Schwamm L, Rost N. Prestroke Dementia is Associated With Poor Outcomes After Reperfusion Therapy Among Elderly Stroke Patients. Journal Of Stroke And Cerebrovascular Diseases 2011, 22: 718-724. PMID: 22182760, PMCID: PMC3310930, DOI: 10.1016/j.jstrokecerebrovasdis.2011.11.005.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAged, 80 and overDementiaDisability EvaluationFemaleFibrinolytic AgentsHospicesHospital MortalityHumansInfusions, Intra-ArterialInfusions, IntravenousLogistic ModelsMaleMultivariate AnalysisOdds RatioPatient DischargeRehabilitation CentersRetrospective StudiesRisk FactorsSkilled Nursing FacilitiesStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeConceptsIntra-arterial reperfusion therapyTissue plasminogen activatorReperfusion therapyPrestroke dementiaHospital mortalityDischarge destinationPoor outcomeStroke patientsElderly acute stroke patientsMultivariate logistic regression modelAcute reperfusion therapyGuidelines-Stroke databaseSymptomatic intracranial hemorrhageHealth Stroke ScaleHospital mortality rateAcute stroke patientsPowerful independent predictorVascular risk factorsElderly stroke patientsPresence of dementiaLikelihood of deathYears of ageLogistic regression modelsStroke ScaleSecondary outcomesUse of Telemedicine and Other Strategies to Increase the Number of Patients That May Be Treated with Intravenous Thrombolysis
Silva G, Schwamm L. Use of Telemedicine and Other Strategies to Increase the Number of Patients That May Be Treated with Intravenous Thrombolysis. Current Neurology And Neuroscience Reports 2011, 12: 10-16. PMID: 21997715, DOI: 10.1007/s11910-011-0235-6.Peer-Reviewed Original ResearchMeSH KeywordsClinical Trials as TopicFibrinolytic AgentsHumansInfusions, IntravenousStrokeTelemedicineThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorUnited StatesConceptsAcute ischemic strokeUse of telemedicineIntravenous thrombolysisIschemic strokeIntravenous tissue plasminogen activator useAdult long-term disabilityTissue plasminogen activator useLong-term disabilityAmerican Heart AssociationNumber of patientsRecruitment of patientsRate of treatmentHelp of telemedicineThrombolysis trialsHeart AssociationStroke NetworkStroke systemsTelestroke networkTelestroke systemCurrent evidencePatientsThrombolysisStrokeCareTelemedicineOutcomes in Mild or Rapidly Improving Stroke Not Treated With Intravenous Recombinant Tissue-Type Plasminogen Activator
Smith E, Fonarow G, Reeves M, Cox M, Olson D, Hernandez A, Schwamm L. Outcomes in Mild or Rapidly Improving Stroke Not Treated With Intravenous Recombinant Tissue-Type Plasminogen Activator. Stroke 2011, 42: 3110-3115. PMID: 21903949, DOI: 10.1161/strokeaha.111.613208.Peer-Reviewed Original ResearchConceptsRecombinant tissue-type plasminogen activatorIntravenous recombinant tissue-type plasminogen activatorHealth Stroke Scale scoreStroke Scale scoreTissue-type plasminogen activatorHospital dischargePoor outcomeRisk factorsNationwide studyScale scorePoor short-term outcomePlasminogen activatorInitial National InstitutesHigher National InstitutesIschemic stroke patientsLipid-lowering medicationsVascular risk factorsMultivariable-adjusted analysesShort-term outcomesStroke-related disabilityLarge nationwide studyNational InstituteReperfusion therapyHome dischargeIndependent predictorsThrombolysis Treatment for Acute Stroke: Issues of Efficacy and Utilization in Women
Reeves M, Wilkins T, Lisabeth L, Schwamm L. Thrombolysis Treatment for Acute Stroke: Issues of Efficacy and Utilization in Women. Women's Health 2011, 7: 383-390. PMID: 21612358, DOI: 10.2217/whe.11.31.Peer-Reviewed Original ResearchConceptsThrombolysis treatmentIschemic strokeObservational studyTPA treatmentSex differencesAcute ischemic strokeComparable control groupImportant sex differencesIssues of efficacyThrombolysis trialsAcute strokeStroke communityTreatment efficacyControl groupGreater efficacyTrial dataStrokeWomenEfficacyLow utilizationGood evidenceMore studiesTreatmentMenWide variability
2009
Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic strokeSYMBOL
Rost N, Masrur S, Pervez M, Viswanathan A, Schwamm L. Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic strokeSYMBOL. Neurology 2009, 73: 1957-1962. PMID: 19940272, PMCID: PMC4109188, DOI: 10.1212/wnl.0b013e3181c5b46d.Peer-Reviewed Original ResearchConceptsTissue plasminogen activatorEmergency departmentAbsolute contraindicationStroke patientsAmerican Heart Association/American Stroke Association guidelinesAcute ischemic stroke patientsAmerican Stroke Association guidelinesGuidelines-Stroke databaseIschemic stroke patientsCurrent practice guidelinesReferral centerRelative contraindicationThrombolysis patientsEarly administrationRetrospective reviewStroke databaseThrombolytic therapyTreatable factorsDiagnostic neuroimagingAssociation guidelinesClinical evaluationPractice guidelinesBleeding diathesisCoagulopathyPatientsRemote Supervision of IV-tPA for Acute Ischemic Stroke by Telemedicine or Telephone Before Transfer to a Regional Stroke Center Is Feasible and Safe
Pervez M, Silva G, Masrur S, Betensky R, Furie K, Hidalgo R, Lima F, Rosenthal E, Rost N, Viswanathan A, Schwamm L. Remote Supervision of IV-tPA for Acute Ischemic Stroke by Telemedicine or Telephone Before Transfer to a Regional Stroke Center Is Feasible and Safe. Stroke 2009, 41: e18-e24. PMID: 19910552, PMCID: PMC3383769, DOI: 10.1161/strokeaha.109.560169.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overBrain IschemiaFeasibility StudiesFemaleFollow-Up StudiesHospitalizationHumansInfusions, IntravenousMaleMiddle AgedPatient TransferProspective StudiesRemote ConsultationRetrospective StudiesStrokeTelemedicineTelephoneTime FactorsTissue Plasminogen ActivatorYoung AdultConceptsTissue plasminogen activatorOSH patientsCatheter-based reperfusionGuidelines-Stroke databaseAcute ischemic strokeOutcomes of patientsRegional stroke centerDischarge functional statusRSC patientsTelestroke patientsIntravenous thrombolysisIschemic strokeIV-tPARankin scoreSevere strokeStroke centersSymptom onsetTPA infusionRetrospective reviewStroke databaseStroke specialistsFunctional outcomeFunctional statusTelephone consultationsSystemic hemorrhageCost-Effectiveness of Patient Selection Using Penumbral-Based MRI for Intravenous Thrombolysis
Earnshaw S, Jackson D, Farkouh R, Schwamm L. Cost-Effectiveness of Patient Selection Using Penumbral-Based MRI for Intravenous Thrombolysis. Stroke 2009, 40: 1710-1720. PMID: 19286581, DOI: 10.1161/strokeaha.108.540138.Peer-Reviewed Original ResearchMeSH KeywordsAgedAlgorithmsCerebral HemorrhageCost-Benefit AnalysisDecision Support TechniquesFemaleFibrinolytic AgentsHumansImage Processing, Computer-AssistedInfusions, IntravenousMagnetic Resonance ImagingMalePatient SelectionProportional Hazards ModelsQuality-Adjusted Life YearsStrokeThrombolytic TherapyTomography, X-Ray ComputedTreatment OutcomeConceptsMRI selection
2005
Poor Outcomes in Patients Who Do Not Receive Intravenous Tissue Plasminogen Activator Because of Mild or Improving Ischemic Stroke
Smith E, Abdullah A, Petkovska I, Rosenthal E, Koroshetz W, Schwamm L. Poor Outcomes in Patients Who Do Not Receive Intravenous Tissue Plasminogen Activator Because of Mild or Improving Ischemic Stroke. Stroke 2005, 36: 2497-2499. PMID: 16210552, DOI: 10.1161/01.str.0000185798.78817.f3.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorTissue plasminogen activatorNeurological worseningPoor outcomeHealth Stroke Scale scoreProspective single-center studyPlasminogen activatorStroke Scale scoreSingle-center studyIschemic stroke symptomsTPA eligibilityHome dischargeIschemic strokeNeurological deficitsSymptom onsetStroke symptomsSeverity criteriaPatientsScale scoreNational InstituteSubstantial minoritySymptomsStrokeWorseningOutcomes