title: Recombinant tissue-type plasminogen activator use for ischemic stroke in the United States: a doubling of treatment rates over the course of 5 years.
abstract: OBJECTIVE
  Recombinant tissue-type plasminogen activator (rtPA) is the only approved therapy for acute ischemic stroke (AIS). In 2004, 1.8% to 2.1% of AIS patients in the United States received rtPA. Given incentives from regulatory agencies and payors to increase rtPA use, we hypothesized that rtPA use in the United States would increase from 2005 to 2009.
  
  
  METHODS
  AIS cases were defined by exclusion of hemorrhagic stroke and transient ischemic attack International Classification of Diseases 9th revision codes (430, 431, 432, and 435) from diagnosis-related groups 14, 15, 524, and 559 discharges. Patients receiving thrombolytics were identified using International Classification of Diseases 9th revision code 99.10 (Medicare Provider and Analysis Review and Premier databases) and pharmacy billing records (Premier). Change over time and differences between databases were tested using negative binomial regression.
  
  
  RESULTS
  Within Medicare Provider and Analysis Review, thrombolytic use increased from 1.1% in 2005 to 3.4% in 2009 (P<0.001 for trend). Within Premier, thrombolytic use increased from 1.4% in 2005 to 3.7% in 2009 for all cases (P<0.001). Analysis of pharmacy billing records in Premier for 50-mg or 100-mg doses of rtPA showed that 3.4% of AIS cases were treated in 2009. Inclusion of patients with transient ischemic attack or hemorrhagic stroke International Classification of Diseases 9th revision codes who received any thrombolytic as "ischemic stroke patients receiving rtPA" changed the rate of thrombolysis to 5.2%.
  
  
  CONCLUSIONS
  In 2009, 3.4% to 5.2% of AIS patients in the United States received thrombolytics, approximately double the rate of treatment in 2005. Rapid recognition and transport and quick treatment in the emergency department remain goals for further improving treatment rates.
authors.affiliation: UC Neuroscience Institute, Department of Emergency Medicine, 231 Albert Sabin Way, ML 0769, University of Cincinnati Medical Center, Cincinnati, OH 45267-0525, USA. opeolu.adeoye@uc.edu
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
authors.forename: Richard
authors.initials: R
authors.lastname: Hornung
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleindorfer
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy*; D003627:Data Interpretation, Statistical; D017048:Health Care Costs; D006801:Humans; D007345:Insurance Claim Review; D006278:Medicare; D008875:Middle Aged; D010604:Pharmacy / Q000706:statistics & numerical data; D011994:Recombinant Proteins / Q000627:therapeutic use; D012044:Regression Analysis; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator