Thrombolysis for Ischemic Stroke in the United States: Data from National Hospital Discharge Survey 1999-2001

Qureshi, Adnan I; Suri, M. Fareed K.; Nasar, Abu; He, Wei; Kirmani, Jawad F.; Divani, Afshin A.; Prestigiacomo, Charles J.; Low, Ronald B.

doi:10.1227/01.neu.0000175546.62088.d6

Cited by 80 publications

(35 citation statements)

References 19 publications

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“…We compared transfer times between those who underwent emergent angiography for IAT versus those who did not using 2 or Fisher exact tests, Student t tests, and Mann-Whitney U tests as appropriate. We also performed correlational statistics among relevant continuous variables.…”

Section: Discussionmentioning

confidence: 99%

“…However, only 1% to 2% of AIS patients are treated with intravenous (IV) tissue plasminogen activator (tPA) in the United States. [1][2][3] The most common exclusion is arrival Ͼ3 hours from symptom onset. 4 Recent advances in stroke medicine including an extended IV tPA window and intra-arterial therapies (IAT) such as embolectomy may allow more patients to be considered for revascularization therapies up to 8 hours from stroke symptom onset.…”

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confidence: 99%

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Transfer Delay Is a Major Factor Limiting the Use of Intra-Arterial Treatment in Acute Ischemic Stroke

Prabhakaran

Ward

John

et al. 2011

Stroke

152

108

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Background and Purpose-The development of comprehensive stroke centers within hub-and-spoke stroke networks offers the opportunity to increase the proportion of acute ischemic stroke patients treated with intra-arterial therapies (IAT). Interhospital transfer delays will be critical in evaluating the success of this strategy. Methods-We collected data on consecutive patients who were transferred to our institution for possible IAT. We defined transfer time as time elapsed from initial transfer call to arrival at our hospital and assessed whether transfer time was a predictor of emergent angiography using multivariable logistic regression.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Transfer Delay Is a Major Factor Limiting the Use of Intra-Arterial Treatment in Acute Ischemic Stroke

Prabhakaran

Ward

John

et al. 2011

Stroke

152

108

View full text Add to dashboard Cite

show abstract

“…[1][2][3] There are many reasons for this underutilization, including patient factors as well as physician and hospital factors. Among the patient factors that exclude patients from receiving tPA are that patients present outside the treatment window or otherwise fail to meet inclusion criteria for the treatment.…”

Section: Introductionmentioning

confidence: 99%

Safe and Effective Implementation of Telestroke in a US Community Hospital Setting

Zachrison

Shen

Sangha

et al. 2016

TPJ

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Context: There is substantial hospital-level variation in use of tissue plasminogen activator (tPA) for treatment of acute ischemic stroke. Telestroke services can bring neurologic expertise to hospitals with fewer resources.Objective: To determine whether implementation of a telestroke intervention in a large integrated health system would lead to increased tPA utilization and would change rates of hemorrhagic complications.Design: A stepped-wedge cluster randomized trial of 11 community hospitals connected to 2 tertiary care centers via telestroke, implemented at each hospital incrementally during a 1-year period. We examined pre-and postimplementation data from July 2013 through January 2015. A 2-level mixed-effects logistic regression model accounted for the staggered rollout.Main Outcome Measures: Receipt of tPA. Secondary outcome was the rate of significant hemorrhagic complications.Results: Of the 2657 patients, demographic and clinical characteristics were similar in pre-and postintervention cohorts. Utilization of tPA increased from 6.3% before the intervention to 10.9% after the intervention, without a significant change in complication rates. Postintervention patients were more likely to receive tPA than were preintervention patients (odds ratio = 2.0; 95% confidence interval = 1.2-3.4). Before implementation, 8 of the 10 community hospitals were significantly less likely to administer tPA than the highest-volume tertiary care center; however, after implementation, 9 of the 10 were at least as likely to administer tPA as the highest-volume center.Conclusion: Telestroke implementation in a regional integrated health system was safe and effective. Community hospitals' rates of tPA utilization quickly increased and were similar to the largest-volume tertiary care center.

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“…These reports have included a wide range of study designs including prospective studies from academic medical centers, 5,6 or community-based hospitals, 7 retrospective studies from community-based hospitals, 8,9 stroke registries, 10 -12 and administrative databases. 13,14 Although previous reviews have suggested that that the use of IV rt-PA is lower in women, 15 as far as we are aware, no systematic review or meta-analysis has been conducted to determine whether there is a genderbased disparity in the use of IV rt-PA for acute ischemic stroke, and whether such a discrepancy is a consistent finding across studies.…”

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confidence: 99%

Sex Differences in the Use of Intravenous rt-PA Thrombolysis Treatment for Acute Ischemic Stroke

Reeves

Bhatt

Jajou

et al. 2009

Stroke

135

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Background and Purpose-Some studies report that women are less likely to receive IV rt-PA treatment for stroke than men. We undertook a meta-analysis to determine whether a sex disparity existed. Methods-We identified studies that reported sex-specific IV rt-PA treatment rates for acute stroke. Eligible studies included acute stroke admissions from single or multiple hospitals, registries, or administrative databases. Random effects odds ratios (OR) and 95% confidence intervals (CI) were generated to quantify sex differences (females versus males) among all ischemic stroke admissions and among the eligible subgroup who arrived within 3 hours without contraindications. Study design and geographic location were explored as sources of heterogeneity. Results-Eighteen studies were included. Study designs included single hospitals (nϭ5), multiple hospitals (nϭ6), registries (nϭ4), and administrative databases (nϭ3). The summary OR was 0.70 (95% CIϭ0.55 to 0.88) indicating that women had a 30% lower odds of receiving rt-PA treatment than men. However, substantial between-study variability existed. Among 13 hospital-based studies, the summary OR was 0.78 (95% CIϭ0.71 to 0.86) with no significant heterogeneity. Among the 3 administrative studies, the OR was 0.55 (95% CIϭ0.34 to 0.90) but with significant heterogeneity. Among 4 studies that included data on the eligible subgroup, women had a nonsignificant lower odds of treatment (ORϭ0.81, 95% CIϭ0.58 to 1.13). Conclusions-Despite the presence of significant between-study variation, women with acute stroke were consistently less likely to receive thrombolysis treatment compared with men. Further studies to explore the origins of this sex disparity are warranted.

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Thrombolysis for Ischemic Stroke in the United States: Data from National Hospital Discharge Survey 1999-2001

Abstract: The present study provides national estimates of patients undergoing thrombolysis for ischemic stroke. Further efforts need to be made to increase the proportion of patients with ischemic stroke who receive thrombolysis in the United States.

Cited by 80 publications

References 19 publications

Transfer Delay Is a Major Factor Limiting the Use of Intra-Arterial Treatment in Acute Ischemic Stroke

Transfer Delay Is a Major Factor Limiting the Use of Intra-Arterial Treatment in Acute Ischemic Stroke

Safe and Effective Implementation of Telestroke in a US Community Hospital Setting

Sex Differences in the Use of Intravenous rt-PA Thrombolysis Treatment for Acute Ischemic Stroke

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