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Hospitals Increasingly Give Powerful Clot-Buster for Stroke

Posted August 27, 2013

The use of a potentially lifesaving, clot-busting drug — called tissue plasminogen activator (tPA) — to treat patients with ischemic stroke nearly doubled between 2003 and 2011, according to a large new study.

An ischemic stroke occurs when a clot blocks blood flow to the brain. Guidelines recommend giving tPA within 4.5 hours of stroke onset.

Researchers analyzed data from over 1 million ischemic stroke patients treated at nearly 1,700 U.S. hospitals between 2003 and 2011. All of the hospitals in the study were part of an American Heart Association quality improvement program to increase adherence to stroke guidelines.

At these hospitals, use of tPA increased from 4 percent to 7 percent during the nine-year study period. Among patients who were quickly brought to hospital and did not have any medical conditions that would prevent safe use of the drug, tPA administration increased from 43 percent to 77 percent.

There was also increased use of tPA to treat patients with less serious stroke symptoms, those aged 80 and over, and black, Hispanic and other nonwhite patients, according to the study published online Aug. 20 in the journal Circulation: Cardiovascular Quality and Outcomes.

“Hospitals have put tremendous efforts in the past decade into increasing the number of patients who can be treated with intravenous tPA, and this paper suggests those efforts are paying off,” study corresponding author Dr. Lee Schwamm, executive vice chair of neurology and director of stroke services at Massachusetts General Hospital, and a professor of neurology at Harvard Medical School, said in a hospital news release.

“Today, more than three-quarters of stroke patients who are eligible for IV tPA are getting this treatment at the more than 1,600 U.S. hospitals we studied,” he added.

It’s likely that the increased use of tPA “happened because, as providers get comfortable using this drug and seeing good patient outcomes, they become more willing to treat all eligible patients and not just those they feel are the ‘cream of the crop’ for treatment,” Schwamm said.

Despite these findings, tPA is still underutilized, he emphasized.

“We should be providing intravenous tPA to all eligible patients, which means that nearly a quarter of them are still missing that opportunity. Patients and their loved ones need to recognize the signs of a stroke and get to the hospital quickly by calling 911, and hospitals need to be ready to provide rapid diagnosis and treatment,” Schwamm said.

SOURCE: Massachusetts General Hospital, news release

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