IV tissue plasminogen activator use in acute stroke: experience from a statewide registry.
OBJECTIVE
To assess the use of IV recombinant tissue plasminogen activator (rt-PA) in a statewide hospital-based stroke registry and to identify factors associated with its use among eligible patients.


METHODS
A modified stratified sampling scheme was used to obtain a representative sample of 16 hospitals. Prospective case ascertainment and data collection were used to identify all acute stroke admissions over a 6-month period. Subjects eligible for IV rt-PA were defined as those who arrived within 3 hours of onset, who had no evidence of hemorrhage on initial brain image, and who had no physician-documented reasons for non-treatment with IV rt-PA. Multivariate logistic regression was used to identify factors associated with IV rt-PA use.


RESULTS
Of 2,566 stroke admissions, 330 (12.9%) met the eligibility criteria for rt-PA treatment, and of these 43 (13%) received IV rt-PA treatment. Among 2,236 admissions excluded from consideration, 21% had evidence of hemorrhage on initial imaging, 35% had unknown stroke onset times, 38% had an onset to arrival time >3 hours, and 6% had physician documented contraindications. Among eligible patients, being male, use of emergency medical services, and rapid presentation were associated with increased IV rt-PA use.


CONCLUSIONS
Treatment with IV rt-PA was underutilized in this hospital-based stroke registry. The primary reason for nontreatment was delayed presentation. Reducing prehospital and in-hospital response times would help increase IV rt-PA use, as would greater emergency medical services use. Improving the documentation of onset times would help clarify the underlying causes of delayed presentation.
Deng
Y Z
YZ
Department of Epidemiology, Michigan State University, East Lansing, MI 48824, USA.
Reeves
M J
MJ
Jacobs
B S
BS
Birbeck
G L
GL
Kothari
R U
RU
Hickenbottom
S L
SL
Mullard
A J
AJ
Wehner
S
S
Maddox
K
K
Majid
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004363:Drug Utilization / Q000706:statistics & numerical data; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage* / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy*; D013997:Time Factors
D011994:Recombinant Proteins; D010960:Plasminogen Activators