Assessment of Stroke Priority Status on Door-to-Reversal Time and Outcomes in Anticoagulant Associated Intracranial Hemorrhage

Background: The emergent reversal of anticoagulation in the setting of intracranial hemorrhage (ICH) is critical, and it is essential that comprehensive stroke centers adhere to the American Heart Association (AHA) metrics for door-to-reversal within the designated 90 minutes. The objective of this review is to evaluate individuals classified as stroke alert priority 1 and non-stroke alert and compare AHA metrics for door-to-reversal times and clinical outcomes when diagnosed with ICH. Methods: Single-center observational, retrospective review that compared stroke alert priority 1 individuals to non-stroke alert individuals who were diagnosed with an ICH and taking an anticoagulant prior to admission. The primary outcome was the door-to -reversal time in individuals with stroke alert priority 1 versus those with non-stroke alert status. Results: Stroke alert priority 1 individuals had a median door-to-reversal time of 80 minutes compared to 158 minutes in non-stroke alert individuals. Door to computed tomography (CT) was 35 minutes in stroke alert priority 1 compared to 140 minutes in non-stroke alert. For safety outcomes, no thrombotic events were experienced within 30 days in stroke alert priority 1 individuals; however, 13.3% (n = 2) experienced a thrombotic event in non-stroke alert. The most common chief complaints identified in non-stroke alert individuals included falls, headaches, and hypertension. Death within 30 days occurred in 30% (n = 6) of stroke alert priority 1 individuals and 6.7% (n = 1) of non-stroke alert individuals. Discussion: The area for optimization of door-to-reversal is for non-stroke alert individuals who are presenting with a chief complaint of fall, headache, and hypertension while taking an anticoagulant prior to admission. Future direction includes optimizing the triage process to ensure individuals promptly receive a CT.