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Tissue plasminogen activator usually not given within 60 minutes despite improved survival

FRIDAY, Feb. 11 (HealthDay News) -- Fewer than a third of stroke patients receive intravenous tissue plasminogen activator (tPA) within 60 minutes of hospital admission even though timely tPA is associated with significantly reduced in-hospital mortality and fewer complications, according to research published online Feb. 10 in Circulation to coincide with presentation at the American Stroke Association's International Stroke Conference 2011, held from Feb. 9 to 11 in Los Angeles.

Gregg C. Fonarow, M.D., of the University of California in Los Angeles, and colleagues evaluated data from 1,082 hospitals from the American Heart Association/American Stroke Association's Get With The Guidelines-Stroke quality improvement program between April 2003 and September 2009 to assess the frequency, patient and hospital characteristics, trends, and outcomes of ischemic stroke patients with door-to-needle times of 60 minutes or less. The investigators specifically evaluated 25,504 acute ischemic stroke patients treated with tPA within three hours of symptom onset.

The investigators found that just 26.6 percent received tPA in 60 minutes or less, improving from 19.5 percent in 2003 to 29.1 percent in 2009. Patients who were younger, male, white, and had no prior stroke were most likely to receive tPA within 60 minutes. In another study, Fonarow and colleagues found that in-hospital mortality was significantly lower among patients treated more timely with tPA, with these patients experiencing fewer complications.

"These findings suggest there is a critical need for a targeted campaign tailored to increase the portion of patients with door-to-needle times 60 minutes or less, such as the recently launched American Stroke Association Target: Stroke initiative," Fonarow said in a statement. "Nearly 1,000 hospitals across the country are now registered to use Target: Stroke information and tools to improve their door-to-needle time for administering tPA to appropriate stroke patients."

Get With The Guidelines-Stroke, which supported this research, was funded by Bristol-Myers Squib/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable; it was previously supported by Boeringher-Ingelheim and Merck. Study authors disclosed financial relationships with these and other pharmaceutical companies.

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