Effect of emergent magnetic resonance imaging on alteplase utilization for acute ischemic stroke

Abstract

Objectives: The purpose of this project was to assess appropriateness of alteplase (tPA) administration in patients undergoing magnetic resonance imaging (MRI) at Banner-University Medical Center Tucson (BUMC-T) and identify interruptions in therapy that could have been prevented. Methods: This descriptive quality improvement project evaluated retrospective data from the electronic health records at BUMC-T. Data was collected from patient charts using Epic. The data collection form included items based on demographics, tPA, symptoms and severity, utilization of computerized tomography, MRI, interventional radiology (IR), and complications. Wilcoxon Rank-sum test was used to compare the door-to-needle times if patients did or did not receive an MRI. Fisher’s exact test was used to compare the proportion of patients with interruption of infusion with or without emergent MRI (P<0.050). Main Results: Ninety-six patients received tPA for acute ischemic stroke with 13 having an interruption in infusion. Reasons documented were placed into 4 categories: MRI related, blood pressure related, adverse reactions related to tPA, or other. Four of 13 interruptions were related to an emergent MRI. This was not statistically significant (p>0.050). The remainder were not preventable as tPA was discontinued because of an adverse event. Patients that received an MRI received tPA faster than those patients who did not receive an MRI (48 minutes versus 63 minutes, respectively) (P=0.006).

Conclusions: Alteplase interruptions did not occur more frequently in patients who received MRI. However, all preventable interruptions were due to MRI. Alteplase administration logistics should be optimized to minimize any preventable interruptions in therapy.