National US Estimates of Recombinant Tissue Plasminogen Activator Use

Abstract

Background and Purpose-Current US estimates of recombinant tissue plasminogen activator (rt-PA) use have been based either on extrapolation of regional studies or on administrative database estimates, both of which may have inherent biases. We sought to compare the utilization of rt-PA in acute ischemic stroke in the MEDPAR database to another national hospital database with drug utilization information. Methods-Cases

Acute stroke intervention by interventional cardiologists

“…It is estimated that only 2-5% of all patients presenting with ischemic stroke receive intravenous thrombolysis. The primary reason for exclusion is the narrow time window (<3 hr) from the onset of symptoms to treatment [5][6][7][8]. Though efforts are underway to educate the public about the warning signs of stroke and the need to seek care rapidly, the estimated ceiling of eligible patients who could benefit from intravenous thrombolysis remains 1 in 5 of all ischemic stroke patients [9].…”

Stroke Knowledge in an Irish Semi-Rural Community-Dwelling Cohort and Impact of a Brief Education Session

“…Outcomes might be more closely associated with an awareness of the treatments available for acute stroke. 9,10 The poor awareness of stroke thrombolytic therapy found in this study is disturbing. It might be related to the poor availability of this treatment in Ireland, as noted in the First Irish National Audit on Stroke Care.…”

“…30 Consequently, based on a 50% response rate, 11% of this current study population might be eligible for thrombolysis. However, rates of thrombolytic therapy are as low as 1.8%, 9 suggesting that action in response to stroke might not be related to knowledge of stroke. Outcomes might be more closely associated with an awareness of the treatments available for acute stroke.…”

“…3,7,8 Despite advances in stroke treatment, particularly in thrombolytic therapy, as few as 1.8%-2.1% of ischemic stroke patients receive this treatment. 9,10 Poor knowledge regarding the significance of and appropriate emergency response to stroke symptoms is a major factor leading to delayed presentation to hospital, which is the most common reason why stroke patients do not receive thrombolytic therapy. [10][11][12][13] Stroke education programs using mass media have proven effective in increasing the public's awareness of stroke, 9,14-17 reducing time delays for hospital presentation, 17,18 and increasing the rate of thrombolytic therapy in stroke patients.…”

Advanced neuroimaging in acute ischemic stroke: extending the time window for treatment

“…31 Among these is the requirement for a 3-hour interval, from onset of symptoms to initiation of therapy. Recent data, however, suggest that the benefits of tPA may extend beyond the 3-hour cutoff.…”