Volume 5, Issue 7 p. 406-409
Original Research

Trends in thrombolytic use for ischemic stroke in the United States

Margaret C. Fang MD, MPH

Corresponding Author

Margaret C. Fang MD, MPH

Division of Hospital Medicine, The University of California, San Francisco, San Francisco, California

Telephone: 415-502-7100; Fax: 415-514-2094

University of California, San Francisco, Division of Hospital Medicine, 533 Parnassus Ave., Box 0131, San Francisco, CA 94143Search for more papers by this author
David M. Cutler PhD

David M. Cutler PhD

Harvard University Department of Economics and Kennedy School of Government, Cambridge, Massachusetts

National Bureau of Economic Research, Cambridge, Massachusettss

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Allison B. Rosen MD, MPH, ScD

Allison B. Rosen MD, MPH, ScD

National Bureau of Economic Research, Cambridge, Massachusettss

The University of Michigan, Departments of Internal Medicine and Health Management and Policy, Ann Arbor, Michigan

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First published: 23 June 2010
Citations: 101

This work was supported by a National Institute on Aging grant P01 AG17625. Dr. Fang was supported by a National Institute on Aging Paul B. Beeson Career Development Award AG028978.

Disclosure: Nothing to report.

Abstract

BACKGROUND:

Although recombinant tissue plasminogen activator (tPA) improves outcomes from ischemic stroke, prior studies have found low rates of administration. Recent guidelines and regulatory agencies have advocated for increased tPA administration in appropriate patients, but it is unclear how many patients actually receive tPA.

OBJECTIVE:

To determine whether national rates of tPA use for ischemic stroke have increased over time.

METHODS:

We identified all patients with a primary diagnosis of ischemic stroke from years 2001 to 2006 in the National Hospital Discharge Survey (NHDS), a nationally representative sample of inpatient hospitalizations, and searched for procedure codes for intravenous thrombolytic administration. Clinical and demographic factors were obtained from the survey and multivariable logistic regression used to identify independent predictors associated with thrombolytic use.

RESULTS:

Among the 22,842 patients hospitalized with ischemic stroke, tPA administration rates increased from 0.87% in 2001 to 2.40% in 2006 (P < 0.001 for trend). Older patients were less likely to receive tPA (adjusted odds ratio [OR] and 95% confidence interval [CI]; 0.4 [0.3-0.6] for patients ≥80 years vs. <60 years), as were African American patients (0.4 [0.3-0.7]). Larger hospitals were more likely to administer tPA (3.3 [2.0-5.6] in hospitals with at least 300 beds compared to those with 6-99 beds).

CONCLUSIONS:

Although tPA administration for ischemic stroke has increased nationally in recent years, the overall rate of use remains very low. Larger hospitals were more likely to administer tPA. Further efforts to improve appropriate administration of tPA should be encouraged, particularly as the acceptable time-window for using tPA widens. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.