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Implementation of a prealert to improve in-hospital treatment of anticoagulant-associated strokes: analysis of a prehospital pathway change in a large UK centralised acute stroke system
  1. Christopher Ashton1,
  2. Camilla Sammut-Powell2,
  3. Emily Birleson3,
  4. Duncan Mayoh4,
  5. Matthew Sperrin5,
  6. Adrian R Parry-Jones3,6
  1. 1Greater Manchester Stroke Operational Delivery Network, Salford, UK
  2. 2Centre for Health Informatics, The University of Manchester, Manchester, UK
  3. 3Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
  4. 4North West Ambulance Service NHS Trust, Bolton, UK
  5. 5Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
  6. 6Division of Cadiovascular Sciences, The University of Manchester, Manchester, UK
  1. Correspondence to Dr Adrian R Parry-Jones; adrian.parry-jones{at}manchester.ac.uk

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Introduction

Intracerebral haemorrhage (ICH) has the worst outcomes of all stroke subtypes, with a case fatality at 1 month of 30%–40% and only 20% regaining independence.1 Improving the implementation of existing evidence-based and guideline-recommended interventions may lead to improved outcomes.2 10%–20% of acute ICH occurs in patients taking oral anticoagulants and this is associated with a high risk of early haematoma expansion.3 4 Rapid treatment to normalise coagulation reduces this risk and may improve outcomes.4 5 The first critical step in achieving this is for suspected stroke patients on anticoagulants to undergo immediate brain imaging, allowing ICH to be identified quickly and anticoagulant reversal therapy initiated. Our regional centralised acute stroke system within Greater Manchester and Eastern Cheshire serves a population of 2.85 million and although suspected stroke patients collected by ambulance <48 hours post onset are transported to a hyperacute stroke unit (HASU), only those within 4 hours of onset are prealerted. We conducted a service evaluation to determine whether an additional prealert and emergency transport for suspected stroke on anticoagulants 4–48 hours post onset facilitated rapid imaging and hence reversal of anticoagulation after ICH on HASU arrival. A proposed prealert for anticoagulant-associated suspected strokes was agreed by the Greater Manchester Stroke …

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