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(Stroke. 2006;37:281.)
© 2006 American Heart Association, Inc.

Editorials

IV Tissue Plasminogen Activator for Stroke in the Community

What We Know and Don’t Know 10 Years After FDA Approval

Anthony J. Furlan, MD

From the Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195-5001.

Correspondence to Anthony Furlan, 9500 Euclid Ave, Cleveland, OH, 44195-5001. E-mail furlana@ccf.org

Key Words: stroke, acute • thrombolysis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Bateman et al¹ use the Nationwide Inpatient Sample (NIS) database for 1999 to 2002 to gain insights into the use of IV tissue plasminogen activator (tPA) for acute stroke across a wide range of community hospitals. It is important to note that this was a 20% random sample from NIS and that the ICD 99.10 thrombolysis code is only 50% sensitive for identifying thrombolysis patients. Also, significant variables including baseline stroke severity, neuroimaging data, stroke etiologies, and hospital transfer patterns, as well as 90 day functional outcomes, are not available, which severely limits the conclusions which can be drawn from the database. Thus, although this is the largest "snapshot" we have for IV tPA use in the United States 5 years after FDA approval, the picture remains blurred.

Even allowing for coding inaccuracies, the rate of IV tPA use was distressingly low (2594/250 005=1%). Clinical trials have repeatedly shown that late arrival to hospital and minor or improving neurological deficit are the main reasons patients do not receive IV tPA. In the community this is compounded by difficulty in accessing neurological expertise and by fear of intracerebral hemorrhage. In this regard the study findings are reassuring because the intracerebral hemorrhage rate was only 4.4%. Although the hemorrhage rate was lower than in the NINDS trial, the true rate is uncertain because of inaccuracies inherent in discharge coding. Nonetheless, the NIS hemorrhage rate does suggest that IV tPA can be safely administered in a community setting, which we have also reported . . . [Full Text of this Article]

Related Article:

Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients: An Analysis of the Nationwide Inpatient Sample 1999 to 2002

Brian T. Bateman, H. Christian Schumacher, Bernadette Boden-Albala, Mitchell F. Berman, J.P. Mohr, Ralph L. Sacco, and John Pile-Spellman
Stroke 2006 37: 440-446. [Abstract] [Full Text] [PDF]

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