Doubling the Use of Gold Standard Stroke Rx

Stroke medication is now given to nearly double the percentage of patients from 2003

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) More stroke patients than ever are getting the only FDA-approved treatment for dissolving blood clots. While its use has steadily climbed, the medication is still not reaching all eligible patients.

The American Stroke Association calls tPA (tissue plasminogen activator) the gold standard for stroke treatment. Administered intravenously (through a vein) within the first few hours of symptoms appearing, the medication can clear a blockage in a blood vessel and potentially prevent disability or death.

A new study showed that the use of tPA to treat ischemic stroke nearly doubled from 2003 to 2011. However, about a quarter of patients who could have benefited from the treatment were not receiving it.

"Call 911 at the first sign of stroke symptoms."

Lee Schwamm, MD, executive vice chair of Neurology and director of Stroke Services at Massachusetts General Hospital (MGH) and professor of Neurology at Harvard Medical School, collaborated on this analysis of data on just over a million acute ischemic stroke patients at 1,683 hospitals.

Dr. Schwamm and his team reported that among all patients who were admitted to the participating hospitals for an ischemic stroke within three hours of symptoms appearing, usage of tPA climbed from 4 percent to 7 percent between 2003 and 2011.

Three hours was the outer limit for giving the tPA when it was first introduced in 1996. Guidelines as of 2009 have extended that window to 4.5 hours after symptom onset.

In patients who arrived within two hours and had no medical conditions that would prevent safe use of the medication, tPA administration rose from 43 percent to 77 percent.

The numbers show that currently more than three-quarters of stroke patients who are eligible for tPA are getting the treatment.

The investigators also observed that tPA is being given to a more diverse group of patients. Over the nine-year study, there was increasing use of tPA to treat individuals who had milder stroke symptoms, patients who were 80 years of age and older and those who were non-white.

“We expect that this expansion happened because, as providers get comfortable using this drug and seeing good patient outcomes, they become more willing to treat all eligible patients and not just those they feel are the ‘cream of the crop’ for treatment," said Dr. Schwamm in a statement.

He added that he would like to see all eligible patients receiving tPA, but nearly a quarter of them are missing that opportunity.

“Patients and their loved ones need to recognize the signs of a stroke and get to the hospital quickly by calling 911, and hospitals need to be ready to provide rapid diagnosis and treatment,” Dr. Schwamm said.

Hospitals in this study participate in the Get With the Guidelines—Stroke (GWTG-S) program established by the American Heart Association. This program was created to help hospitals organize stroke teams, establish best practices for treatment, share information with other member hospitals and measure their performance.

“We hope that our results will encourage more hospitals to join GWTG-S or similar stroke quality improvement programs to help accelerate their use of tPA,” said Dr. Schwamm. “When patients learn that their local hospitals are treating stroke more aggressively, that can translate into more awareness and faster action by the public.”

This study was published in August in the journal Circulation: Cardiovascular Quality and Outcomes.

Review Date: 
August 26, 2013
Last Updated:
August 26, 2013