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PHILADELPHIA – Despite evidence that tissue plasminogen activator (tPA) improves recovery from stroke, women and minorities appear to be less likely to receive the clot-busting treatment than other patients.
A study published online recently by the journal Neurology reviewed more than eight years of hospital records from across the country. The University of Pennsylvania-led researchers focused on patients with ischemic stroke who arrived at the hospital within two hours after the start of stroke symptoms and had no documented reasons that they could not receive tPA.
“Even though the clot-busting treatment for stroke called tPA improves recovery, some people who are eligible to receive the treatment are not getting it," explained lead author Steven R. Messé, MD. "We wanted to find out what factors were associated with lower likelihood of treatment, which may help us find ways to improve tPA use in the future."
Results indicate that, of the 61,698 patients in the study, 25% did not receive the treatment within three hours. Treatment rates improved over time, however, with 45% of those eligible receiving treatment from 2003-2005 compared to 82% from 2010-2011, according to the report.
After taking into consideration other factors that could affect treatment, including stroke type and severity, the researchers determined that women and minorities were less likely to receive clot-busting treatment. Specifically, female patients had 8% higher odds of not receiving treatment than men; while women were 50.6% of the total study group, they made up only 50.1% of those receiving treatment.
The disparity was even greater for African-Americans, who had 26% higher odds of not receiving treatment than whites, study authors point out, while those of other races had 17% higher odds of not receiving treatment than whites.
Undertreatment also was found with older patients and those who had suffered less severe strokes, as well as when cases arrived other than by emergency medical services, had longer onset-to-arrival and door-to-CT times, occurred earlier in the calendar year, and were at rural, nonteaching, non-stroke center hospitals located in the South or Midwest.
"More research is needed about why these potential disparities exist and how they can be addressed," Messé said in an American Academy of Neurology press release.
Overall, patients receiving treatment at hospitals certified as stroke centers were more likely to receive treatment than those at hospitals without the certification; those at primary stroke centers had nearly twice the odds of receiving tPA, according to the research.