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Few U.S. Stroke Patients Get Clot-Busting Drugs, Authors Find

Thombolysis rates range from 0% to 9% among Medicare patients

Not all U.S. stroke patients eligible for a clot-busting treatment receive it –– and the odds of getting this therapy may depend on where they live, according to a report from Reuters.

Because thrombolysis generally must be completed within 4.5 hours of the onset of stroke symptoms, a major obstacle to treatment can be getting to the hospital fast enough, lead study author Dr. James Burke, a neurologist at the University of Michigan, told Reuters.

“For a variety of reasons, only a minority of patients get to the hospital within the first couple hours of a stroke,” he said. Patients might not recognize the symptoms or call 911 soon enough, and even when they do seek help quickly, they might not end up at a hospital that’s equipped to provide thrombolysis, he added.

Burke and his colleagues conducted a retrospective cross-sectional study of all fee-for-service Medicare patients with ischemic stroke admitted via the emergency department from 2007 to 2010. They sorted the patients into 3,436 different hospital service areas based on Zip codes to assess the regional variations in thrombolysis treatment rates. The patients’ average age was 78 years; about 57% were women; and most were white. The majority had hypertension, and many also had diabetes, high cholesterol or an irregular heart rhythm.

The investigators found that there were 844,241 ischemic stroke admissions, of which 3.7% received intravenous (IV) tissue-type plasminogen activator and only 0.5% received intra-arterial stroke treatment with or without IV tissue-type plasminogen activator over the 4-year study period. The unadjusted proportion of patients with ischemic stroke who received thrombolysis varied from 9.3% in the highest treatment quintile compared with 0% in the lowest treatment quintile.

Older patients, women and minorities were less likely to receive the treatment.

By boosting the use of thrombolysis in regions where it’s least likely to happen up to the level in places where the therapy is most common, the researchers estimated that an additional 92,847 stroke patients might receive the treatment, averting disability for 8,078 of them.

Their findings were published in the June 2 issue of Stroke.

The best outcomes are for stroke patients who receive thrombolysis within the first hour after the blood vessel becomes blocked, Dr. Brian Silver, director of the Comprehensive Stroke Center at Rhode Island Hospital, told Reuters.

“When patients don’t receive this treatment, they are up to 50% less likely to have a better outcome,” he said. “This means, for some, residual speech difficulties, paralysis, vision loss, cognitive impairment, and depression.”

Sources: Reuters; June 17, 2015; and Stroke; June 2, 2015.

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