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US Study: Thrombolysis Underutilised, Even at Stroke Centres: Presented at ANA
By Charlene Laino
BALTIMORE, Md -- October 20, 2009 -- Only 3% of ischaemic stroke patients treated at US stroke centres between 2004 and 2006 received thrombolytic therapy with recombinant tissue plasminogen activator (r-tPA), a new study shows.
At hospitals that were not designated stroke centres, the number was even lower, 1.3%, reported Leslie K. Lee, a medical student at Columbia University, New York, New York. He presented the findings here on October 12 at the American Neurological Association (ANA) 134th Annual Meeting.
The researchers, led by Mitchell F. Berman, MD, MPH, Columbia University, analysed data from the National Inpatient Sample, a nationally representative database that covers one-fifth of all hospitalisations in the United States.
The Joint Commission, an independent body that certifies healthcare organisations and programmes in the United States based on performance standards, began certifying hospitals as Primary Stroke Centers (PSCs) in 2004. As historical data are not available, the researchers compared treatment rates for 2004 to 2006 at hospitals that were designated as PSCs as of February 2009 and then extrapolated the results.
In logistic regression analysis, significant covariates for receiving thrombolysis were year of treatment, patient race and comorbid status, and hospital geography and teaching status.
A multivariable logistic regression adjusted for patients and hospital characteristics showed that admission to a hospital that went on to become a PSC nearly doubled the odds of receiving thrombolysis (odds ratio, 1.96; 95% confidence interval, 1.61-2.38).
When the first thrombolytic drug was approved by the US Food and Drug Administration for the treatment of acute ischaemic stroke in 1996, the hope was that the treatment would reach many patients, Lee said.
"Clearly that goal has not been met," he said. The major stumbling block has been the limited time window in which r-tPA must be administered, that is, within 3 hours of the onset of stroke symptoms, Lee added.
Based on the results of the third European Cooperative Acute Stroke Study (N Engl J Med 2008;359:1317-1329), a recent American Heart Association/American Stroke Association Science Advisory was updated to state that tPA can be safely given within 4.5 hours in selected patients, he continued.
"Hopefully that will make a difference," but primary care physicians can also help by ensuring that patients know the symptoms of stroke and the need to seek urgent care if stroke is suspected, Lee concluded.
[Presentation title: Thrombolysis at Primary Stroke Centers in the U.S. Abstract M-27]
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