If you're having an ischemic stroke, it's crucial that you get to a hospital fast so you can be treated with a clot-busting medicine. And to improve your odds of getting that medicine, it helps to be a white man.
A new analysis of more than 60,000 stroke patients from around the country found that women were less likely than men to receive an infusion of tissue plasminogen activator, the drug that's considered the gold standard in stroke treatment. The analysis also showed that racial minorities were less likely to get the drug than whites.
The results suggest that "women and minorities may be undertreated" for ischemic strokes, according to a report published Wednesday in the journal Neurology.
Nearly 9 out of 10 strokes are ischemic strokes, which occur when a clot inside a blood vessel blocks blood flow to the brain. If this happens, it's important to remove the obstruction as quickly as possible.
The only medicine designed to do this is tissue plasminogen activator, also known as tPA. When infused into a patient's arm, tPA can dissolve a clot and restore blood flow to the part of the brain that had been cut off.
The tricky part is that in order for tPA to work, the treatment must start within 4½ hours of the onset of a stroke. In most cases, it has to be administered within three hours.
But even when patients get to the hospital in time, roughly one-third of patients still aren't getting tPA. So a research team led by Dr. Steven R. Messe of the Hospital of the University of Pennsylvania went looking for reasons why.
They turned to a national registry of stroke patients that includes more than 2.5 million patient records from 1,800 hospitals. Out of this pool they identified 61,698 patients who had suffered an ischemic stroke and were in a hospital within two hours. None of these patients had a condition that made them ineligible to receive tPA, such as uncontrolled high blood pressure or internal bleeding.
Among these patients, 75% went on to be treated with tPA within three hours of the onset of their stroke, and 25% did not, according to the study.
Next, the researchers adjusted for factors that could influence the decision to use tPA, like the patient's medical history and the size of the hospital they went to. They also focused on the 74% of patients whose records included a National Institutes of Health Stroke Scale score, which is used to assess the severity of a patient's symptoms.
Their analysis showed that the odds of being passed over for tPA were 8% higher for women than for men. Also, compared to white patients, the odds of not getting tPA were 28% higher for African American patients and 17% higher for patients of other races.
The researchers noted that these results were in line with previous studies of stroke patients, but they did not offer any explanation for why the disparities exist.
Several other factors also appeared to influence a patient's chances of receiving the clot-busting medicine. Patients who were at least 70 years old were 13% more likely to be passed over than were younger patients. The odds of not receiving tPA were 12% higher for patients who came to the hospital during off hours, and 14% lower for patients who arrived via ambulance.
Certain characteristics about the hospitals seemed to matter, too. For instance, patients who came to rural hospitals were 46% more likely not to get the drug, while patients brought to teaching hospitals were 79% less likely to meet that fate. Compared with stroke patients treated at hospitals in the Northeast, patients at hospitals in the Midwest andSsouth were more than twice as likely to be in the no-tPA group, according to the study.
At the beginning of the study period in 2003, 55% of stroke patients who were eligible for tPA treatment weren't getting it; by 2011, that figure had dropped to 18%. Despite that overall improvement, the researchers lamented that "up to 1 in 5 potentially eligible patients were not being treated," they wrote.
Although patients can't change their race, age or gender, other factors associated with the odds of tPA treatment have the potential to be modified. "Continued development of systems of care for stroke should remain a high priority," the study authors concluded.
The study was funded in part by grants made to the American Heart Assn. by Pfizer Inc. and the Merck-Schering Plough Partnership.
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