  
Use of tPA in acute stroke "alarmingly" low, especially in African Americans
Last Updated: 2001-05-03 18:33:37 EDT (Reuters Health)
By Megan Rauscher
WESTPORT, CT (Reuters Health) - Intravenous tissue-type plasminogen activator (tPA) is not being utilized appropriately in the US, according to a report in the May issue of Stroke: Journal of the American Heart Association.
Dr. S. Claiborne Johnston of the University of California, San Francisco, and multicenter colleagues determined tPA usage among 1195 consecutive ischemic stroke patients at 42 participating academic medical centers.
Overall, only 4.1% of the patients received intravenous tPA, they report. In a subgroup of 189 patients with no documented contraindication to tPA, only 39 subjects ( 20.6%) received the drug. Among the 285 African-Americans in the study, only 1.1% received tPA compared with 5.3% of the 788 white subjects in the study.
"I was quite surprised that hospitals weren't doing a better job getting tPA to all patients, but I was also startled by the racial disparity," Dr. Johnston told Reuters Health.
Uninsured stroke patients as well as those on Medicaid were one-ninth as likely to receive tPA as patients with private health insurance.
Dr. Johnston suggests physicians examine their "own motivations for not offering the drug. The biases that go on in making treatment decisions may be totally subconscious," she said. "That has to be fixed."
Dr. David Z. Wang, of the University of Illinois, Peoria, points out in an accompanying editorial that more than half of the 42 participating medical centers failed to treat a single African-American stroke patient with tPA.
"Although it is unclear why there are racial and economical disparities in delivering IV tPA to acute ischemic stroke patients, the healthcare system should take immediate actions to raise the awareness of such disparities and make a conscientious effort to change it," Dr. Wang told Reuters Health.
He also urged both academic and nonacademic healthcare institutions to set up stroke programs so that qualifying acute stroke patients will receive prompt and appropriate therapies.
Stroke 2001;32:1061-1066.
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