Trends in thrombolytic use for ischemic stroke in the United States
BACKGROUND: Although recombinant tissue plasminogen activator (tPA) improves
outcomes from ischemic stroke, prior studies have found low rates of administration. Recent
guidelines and regulatory agencies have advocated for increased tPA administration in
appropriate patients, but it is unclear how many patients actually receive tPA. OBJECTIVE:
To determine whether national rates of tPA use for ischemic stroke have increased over
time. METHODS: We identified all patients with a primary diagnosis of ischemic stroke from …
outcomes from ischemic stroke, prior studies have found low rates of administration. Recent
guidelines and regulatory agencies have advocated for increased tPA administration in
appropriate patients, but it is unclear how many patients actually receive tPA. OBJECTIVE:
To determine whether national rates of tPA use for ischemic stroke have increased over
time. METHODS: We identified all patients with a primary diagnosis of ischemic stroke from …
BACKGROUND
Although recombinant tissue plasminogen activator (tPA) improves outcomes from ischemic stroke, prior studies have found low rates of administration. Recent guidelines and regulatory agencies have advocated for increased tPA administration in appropriate patients, but it is unclear how many patients actually receive tPA.
OBJECTIVE
To determine whether national rates of tPA use for ischemic stroke have increased over time.
METHODS
We identified all patients with a primary diagnosis of ischemic stroke from years 2001 to 2006 in the National Hospital Discharge Survey (NHDS), a nationally representative sample of inpatient hospitalizations, and searched for procedure codes for intravenous thrombolytic administration. Clinical and demographic factors were obtained from the survey and multivariable logistic regression used to identify independent predictors associated with thrombolytic use.
RESULTS
Among the 22,842 patients hospitalized with ischemic stroke, tPA administration rates increased from 0.87% in 2001 to 2.40% in 2006 (P < 0.001 for trend). Older patients were less likely to receive tPA (adjusted odds ratio [OR] and 95% confidence interval [CI]; 0.4 [0.3‐0.6] for patients ≥80 years vs. <60 years), as were African American patients (0.4 [0.3‐0.7]). Larger hospitals were more likely to administer tPA (3.3 [2.0‐5.6] in hospitals with at least 300 beds compared to those with 6‐99 beds).
CONCLUSIONS
Although tPA administration for ischemic stroke has increased nationally in recent years, the overall rate of use remains very low. Larger hospitals were more likely to administer tPA. Further efforts to improve appropriate administration of tPA should be encouraged, particularly as the acceptable time‐window for using tPA widens. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
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