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Study: Use of tPA for Ischemic Stroke Nearly Doubled From 2003 to 2011

Clot-dissolving drug still not fully utilized (August 21)

Use of the “clot-busting” drug tissue plasminogen activator (tPA) to treat patients with strokes caused by a blockage of blood flow nearly doubled between 2003 and 2011, according to a paper published online in Circulation: Cardiovascular Quality and Outcomes.

Researchers at Massachusetts General Hospital report both an overall increase in the use of tPA to dissolve clots blocking arteries supplying the brain and administration of the potentially life-saving drug to a more diverse group of patients.

The new study analyzed data on the treatment of 1.09 million acute ischemic stroke patients at 1,683 U.S. hospitals during a 9-year period. Among all patients who were admitted to the participating hospitals for ischemic stroke, the use of tPA increased from 4 percent in 2003 to 7 percent in 2011. In patients who arrived early and were without medical conditions that would prevent safe use of the drug, tPA administration increased from 43 percent to 77 percent.

The study results also indicated increased use of tPA to treat patients with less serious stroke symptoms; those aged 80 years and over; and black, Hispanic, and other nonwhite patients. “We expect that this expansion 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,” explains corresponding author Lee H. Schwamm, MD.

Despite the expansion in tPA usage revealed by the study, the drug is still underutilized, according to Schwamm. “We should be providing intravenous tPA to all eligible patients, which means that nearly a quarter of them are still missing that opportunity,” he says.

Source: Massachusetts General Hospital; August 21, 2013.

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