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Low Usage Rate For tPA For Strokes In Cleveland Area

CHICAGO, IL -- February 29, 2000 -- In one study, Irene L. Katzan, M.D., from the Cleveland Clinic Foundation in Cleveland, and colleagues analyzed data from 29 hospitals in the Cleveland metropolitan area to assess intravenous tPA use, the number of symptomatic intracerebral hemorrhages and patient outcomes, while still at the hospital.

Of the 3,948 patients admitted with a primary diagnosis of ischemic stroke, 1.8 percent (70 patients) received intravenous tPA treatment; 15.7 percent (11) of these patients had a symptomatic intracerebral hemorrhage and 50 percent had treatment that deviated from the national treatment guidelines. For patients treated with tPA, in-hospital mortality was 15.7 percent. For patients who were not treated with tPA, mortality was 5.1 percent.

The researchers found the rates of the use of tPA among the hospitals in the study ranged from 0 percent to 10.2 percent of all ischemic stroke admissions. "The three-hour treatment window for IV [intravenous] tPA is a major factor in the low usage rate," the authors write. "Only 17 percent of ischemic stroke patients arrived at Cleveland hospitals within three hours of symptom onset and of these, only 10.4 percent received IV tPA."

Most of the patients who received tPA (89 percent) were at hospitals that admitted 150 or more stroke patients per year, although the highest rate was reported at a hospital that only admitted 39 stroke patients.

The authors note: "Although neurologists were involved in almost all the cases of IV tPA administered in Cleveland, there was a high frequency of deviations from national guidelines. This suggests a need for better professional education for all physicians caring for patients with acute stroke. The low rate of IV tPA use also emphasizes the need for improved public and professional education about stroke." (The Journal of the American Medical Association (JAMA). 2000;283:1151-1158)

Related Link: The Journal of the American Medical Association (JAMA).

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