Trends in thrombolytic use for ischemic stroke in the United States

• Published in: Journal of hospital medicine Vol. 5; no. 7; pp. 406 - 409
• Main Authors: Fang, Margaret C., Cutler, David M., Rosen, Allison B.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.09.2010
• Subjects: acute stroke; Aged; Aged, 80 and over; Brain Ischemia - drug therapy; Brain Ischemia - mortality; Confidence Intervals; Female; Fibrinolytic Agents - therapeutic use; Health Care Surveys; Health Status Indicators; Humans; Inpatients - statistics & numerical data; ischemic stroke; Length of Stay - statistics & numerical data; Male; Middle Aged; Multivariate Analysis; Odds Ratio; outcomes measurement; Patient Discharge - statistics & numerical data; quality improvement; Quality of Health Care; Risk Assessment; Stroke - drug therapy; Stroke - mortality; thrombolysis; tissue plasminogen activator; Tissue Plasminogen Activator - therapeutic use
• ISSN: 1553-5592; 1553-5606
• DOI: 10.1002/jhm.689

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.