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Few Stroke Patients Get Clot-Busting Drug
Date:2/19/2009

tPA can save lives and reduce disability, but less than 3% of Medicare patients receive it, study shows

THURSDAY, Feb. 19 (HealthDay News) -- A powerful clot-busting drug approved by the U.S. Food and Drug Administration for use in stroke patients in 1996 is still rarely used in Medicare patients, new research shows.

Only 2.4 percent of the more than 495,000 admissions for stroke at the 4,750 hospitals evaluated were given tissue plasminogen activator (tPA), said study author Dr. Dawn Kleindorfer, an associate professor of neurology at the University of Cincinnati College of Medicine. She was to present the finding Thursday at the International Stroke Conference in San Diego.

"The smaller your hospital was, the less likely it was to use tPA," she noted. "The strongest association by far was how big your hospital is."

Larger hospitals may be more likely to have a stroke team or to treat more strokes, and they were therefore more likely to use the drug, she said.

Kleindorfer reviewed national Medicare claims-based database records for every Medicare-eligible hospital discharge in the United States from July 1, 2005, through June 30, 2007.

About 64 percent of the hospitals did not give the clot-buster within the two-year study period, she found.

Across the United States, the use of tPA occurs in no more than 3 percent of all stroke patients, Kleindorfer noted. In this new study, the percent was even lower, at 2.4 percent.

Not every stroke patient is eligible to get tPA, she said. The drug is meant for ischemic stroke, the most common type (in which the blood vessel is clogged by a clot), and the drug must be given intravenously within the first three hours of the onset of symptoms.

Some patients don't make it to the hospital within that time frame, Kleindorfer said, and others are ineligible due to factors such as bleeding in the brain or recent surgery.


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