Strokes can occur when blood clots block an artery (ischemic stroke) or when blood vessels rupture (hemorrhagic stroke), interrupting blood flow to the brain. For some patients with ischemic stroke, IV tPA can help dissolve blood clots and restore blood flow, but this drug must be given within three hours from the start of symptoms. According to the article, national estimates suggest that IV tPA is used in only 2 percent of eligible patients.
Irene L. Katzan, M.D., M.S., of the Cleveland Clinic Foundation, Ohio and colleagues examined the rate of IV tPA use for stroke patients in Cleveland.
The researchers reviewed the medical charts of patients admitted because of stroke to the nine Cleveland Clinic Health System hospitals from June 15, 1999 to June 15, 2000. There were 1,923 admissions for ischemic stroke within this one-year period, and of these, 288 (15 percent) arrived at an emergency department (ED) within the three-hour time window, and approximately 6.9 percent were considered eligible for IV tPA. The most common reasons patients were ineligible for IV tPA even if they arrived within the three-hour window were mild neurologic impairment or rapidly improving symptoms. Overall, the researchers found that the rate of use of IV tPA among patients who arrived at the hospital within the three-hour time period was 19.4 percent, and the rate of use among eligible patients was 43.4 percent.
"Delay to ED presentation was the primary reason that patients with acute stroke did not receive IV tPA in our nine-hospital system in northeastern Ohio; only 15 percent of patients with stroke arrived within three hours of symptom onset," write the authors. "The percentage of patients with stroke arriving at the ED within three hours varies widely in published studies, ranging from 18 percent in a series of academic centers to 46 percent in a community system. However, even the highest rates are suboptimal, and shortening ED arrival times will have the single greatest impact on increasing IV tPA use in the United States."
(Arch Neurol. 2004;61:346-350. Available post-embargo at archneurol.com)
For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org .
Journal
Archives of Neurology