Abstract T P64: Change in UCSD Stroke Center IV tPA Treatment Patterns Over the Last Decade
Background: IV tPA has been approved since 1995, and treatment practices have changed over time. Especially in the last decade, the treatment has become more widely adopted and is offered to more patients. We explored the UCSD stroke center database specifically to assess changes in treatment patterns over time. These could affect clinical trial design, performance and outcomes as the prediction of such is often based on historical information.
Methods: We included all patients with acute ischemic stroke (AIS) from the UCSD Stroke Center Database between 2004 and 2014 (comparing 2004-2009 - Group 1 vs. 2010-2014 - Group 2). We assessed age, sex, race/ethnicity, pre-stroke disability, frequency of IV tPA use (<3 hours between 2004 and 2009; 25 stroke. Good outcomes were defined as discharge to home or acute rehabilitation.
Results: We identified 1,816 patients with AIS from 2004 to 2014 (Group 1: 988, Group 2: 828) and found no difference in age, sex, diabetes, pre-stroke mRS and outcomes between the groups. Mean±SD NIHSS was lower in Group 2 (11.6±8.2 versus 3.6±13.3; p=0.0005) and overall IV tPA use more frequent (332/828 (36.3%) versus 328/988 (33.2%) - p=0.0024). More patients with mild (22.1% versus 12.3%; p=0.0009) and moderate (45.6% versus 41.3%; p=0.02) receive IV tPA. There was no difference in tPA use for patients with NIHSS >14.
Discussion: IV tPA use increased over time, especially in mild and moderate stroke. This may in part be a function of increased treatment times (4.5 hours) or overall increased acceptance of this therapy. It is important to consider these treatment changes over time when planning for research protocols and use caution when comparing current data to historical controls.
Author Disclosures: M.N. Ali: None. R. Raman: None. K. Enstrom: None. H. Ramani: None. D.M. Meyer: Speakers' Bureau; Modest; CHIESI. R. Modir: None. K.S. Rapp: None. B.C. Meyer: Speakers' Bureau; Modest; Genentech. T.M. Hemmen: Consultant/Advisory Board; Modest; MERCK.
- © 2015 by American Heart Association, Inc.