Published Online
on January 31, 2008

A more recent version of this article appeared on March 1, 2008

This Article Full Text (PDF) All Versions of this Article: 39/3/924    most recent STROKEAHA.107.490375v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kleindorfer, D. Articles by Broderick, J. P. Search for Related Content PubMed PubMed Citation Articles by Kleindorfer, D. Articles by Broderick, J. P. Related Collections Other Stroke Treatment - Medical

Submitted on April 24, 2007
Revised on July 11, 2007
Accepted on July 26, 2007

National US Estimates of Recombinant Tissue Plasminogen Activator Use. ICD-9 Codes Substantially Underestimate

Dawn Kleindorfer MD^*; Christopher J. Lindsell PhD; Lawrence Brass MD; Walter Koroshetz MD; and Joseph P. Broderick MD

From the University of Cincinnati College of Medicine (D.K., C.J.L., J.P.B.), Ohio; Yale University (L.B.), New Haven, Conn; and the National Institute of Neurological Disorders and Stroke (W.K.), Bethesda, Md.

^* To whom correspondence should be addressed. E-mail: dawn.kleindorfer{at}uc.edu.

Background and Purpose—Current US estimates of recombinant tissue plasminogen activator (rt-PA) use have been based either on extrapolation of regional studies or on administrative database estimates, both of which may have inherent biases. We sought to compare the utilization of rt-PA in acute ischemic stroke in the MEDPAR database to another national hospital database with drug utilization information.

Methods—Cases were defined as DRG 14,15, and 524 and ICD-9 code 99.1, which indicates cerebral thrombolysis, for fiscal year 2001 to 2004. Additionally, the Premier database was queried for rt-PA utilization documented in pharmacy records in those patients admitted for stroke. Change over time and difference between databases were tested using Poisson regression.

Results—When comparing databases, rt-PA use, as identified by ICD-9 code 99.1, was only documented in 0.95% of stroke cases in 2004 in MEDPAR, and 1.2% in the Premier database, which slightly increased by 0.04% to 0.09% over time. Analysis of pharmacy billing records increased the estimate to 1.82%. Exclusion of cases younger than 65years excluded 43% of cases treated with rt-PA. In 2004, 12.7% of cases receiving thrombolytic had either a TIA or a hemorrhagic stroke ICD-9 code.

Conclusions—We estimate the rate of rt-PA use in the United States to be 1.8% to 2.1% of ischemic stroke patients. The rate of thrombolytic use for ischemic stroke was slightly increasing between 2001 and 2004 at a rate of 0.04% to 0.09% per year. A significant proportion of patients treated with rt-PA are likely miscoded as either TIA or hemorrhagic stroke. We conservatively estimate that 10 800 to 12 600 patients received rt-PA in 2004.

Key words: acute stroke treatment • epidemiology • tPA

This article has been cited by other articles:

				D. Kleindorfer, Y. Xu, C. J. Moomaw, P. Khatri, O. Adeoye, and R. Hornung US Geographic Distribution of rt-PA Utilization by Hospital for Acute Ischemic Stroke Stroke, November 1, 2009; 40(11): 3580 - 3584. [Abstract] [Full Text] [PDF]

				W. Liu, J. Hendren, X.-J. Qin, and K. J. Liu Normobaric Hyperoxia Reduces the Neurovascular Complications Associated With Delayed Tissue Plasminogen Activator Treatment in a Rat Model of Focal Cerebral Ischemia Stroke, July 1, 2009; 40(7): 2526 - 2531. [Abstract] [Full Text] [PDF]

				D. Kleindorfer, J. Khoury, J. P. Broderick, E. Rademacher, D. Woo, M. L. Flaherty, K. Alwell, C. J. Moomaw, A. Schneider, A. Pancioli, et al. Temporal Trends in Public Awareness of Stroke: Warning Signs, Risk Factors, and Treatment Stroke, July 1, 2009; 40(7): 2502 - 2506. [Abstract] [Full Text] [PDF]

				R.G. Nogueira, L.H. Schwamm, and J.A. Hirsch Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 649 - 661. [Abstract] [Full Text] [PDF]

				H.J. Cloft, A. Rabinstein, G. Lanzino, and D.F. Kallmes Intra-Arterial Stroke Therapy: An Assessment of Demand and Available Work Force AJNR Am. J. Neuroradiol., March 1, 2009; 30(3): 453 - 458. [Abstract] [Full Text] [PDF]

				W. A. Copen, L. Rezai Gharai, E. R. Barak, L. H. Schwamm, O. Wu, S. Kamalian, R. G. Gonzalez, and P. W. Schaefer Existence of the Diffusion-Perfusion Mismatch within 24 Hours after Onset of Acute Stroke: Dependence on Proximal Arterial Occlusion Radiology, March 1, 2009; 250(3): 878 - 886. [Abstract] [Full Text] [PDF]

				S. Sato, T. Uehara, K. Toyoda, N. Yasui, T. Hata, T. Ueda, Y. Okada, A. Toyota, Y. Hasegawa, H. Naritomi, et al. Impact of the Approval of Intravenous Recombinant Tissue Plasminogen Activator Therapy on the Processes of Acute Stroke Management in Japan: The Stroke Unit Multicenter Observational (SUMO) Study Stroke, January 1, 2009; 40(1): 30 - 34. [Abstract] [Full Text] [PDF]

				M. L. Flaherty, J. Karlawish, J. C. Khoury, D. Kleindorfer, D. Woo, and J. P. Broderick How important is surrogate consent for stroke research? Neurology, November 11, 2008; 71(20): 1566 - 1571. [Abstract] [Full Text] [PDF]