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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.

Still, the low percentage noted in the study falls far short of the percent of people who should be eligible to get tPA, she said. In fact, Kleindorfer believes that up to 29 percent of stroke patients are probably eligible for the clot-buster drug if they get to medical care within the three-hour window.

From the study, Kleindorfer also found that "40 percent of the U.S. population lives in a city with a hospital that does not treat at the national average [of 3 percent]."

Use of the drug may have been higher, she said, if she had studied younger, non-Medicare patients. In younger patients, she said, it's likely they would have fewer problems such as bleeding in the brain that would rule out use of tPA.

Another expert familiar with the study expressed disappointment at the low percent of tPA usage. "It's still unfortunate that the number of hospitals that can provide acute stroke therapy is still limited," said Dr. Ralph Sacco, chairman of the department of neurology at the University of Miami Miller School of Medicine.

The number of hospitals with stroke teams is increasing, he noted. As more hospitals are designated as a primary stroke center by the Joint Commission on Accreditation of Healthcare Organizations, the use of the drug may increase, experts said.

In the meantime, Kleindorfer had some simple, strong advice for family and friends of those suspected of having a stroke: "Call 9-1-1." Getting help quickly is crucial, she said.

Once at the hospital, she said, tell staff right away that you believe your loved one is having a stroke. "Ask, 'Do you have a stroke team?' 'What about that clot-buster medicine?'"

More information

To learn more about tPA, visit the American Stroke Association.



SOURCES: Dawn Kleindorfer, M.D., neurologist and associate professor, University of Cincinnati College of Medicine; Ralph L. Sacco, M.D., chairman, department of neurology, University of Miami Miller School of Medicine, and American Stroke Association spokesman; Feb. 19, 2009, presentation, International Stroke Conference, San Diego


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