Strategies to speed tPA treatment vary widely, study says

April 21, 2014 – The DCRI’s Ying Xian, MD, PhD, and others surveyed U.S. hospitals about their use of tissue-type plasminogen activator with stroke patients.

Strategies used by hospitals to improve the speed of tissue-type plasminogen activator treatment for stroke patients vary considerably, according to a new study by DCRI researchers.

The study, by Ying Xian, MD, PhD (pictured); Xin Zhao, MS; Eric Peterson, MD, MPH; Adrian Hernandez, MD, MHS; and researchers from other institutions, appears in the online edition of the journal Stroke.

ying-xianTissue-type plasminogen activator (tPA) is a protein that breaks down blood clots and is used to improve the outcomes of stroke victims. However, its effectiveness depends upon how quickly the patient receives the treatment after the initial onset of stroke. Earlier research suggests that for every minute that treatment is delayed in a typical large-vessel ischemic stroke, nearly 2 million neurons die. Rapid treatment is therefore critical to maximizing the odds of a patient’s recovery. Although the current guidelines of the American Heart Association/American Stroke Association recommend that therapy begins within 60 minutes of hospital arrival, times still vary from hospital to hospital. These differences exist in part because hospitals use different strategies when using tPA to treat stroke patients.

To better understand which strategies hospitals are using to shorten these times, the researchers surveyed 304 hospitals in the United States about their usage of tPA in stroke victims who were admitted between 2008 and 2009. Among 5460 patients receiving tPA within 3 hours of symptom onset in surveyed hospitals, the median time from admission to treatment was 72 minutes.

The researchers also found that hospitals employed many different strategies for minimizing these times. Of 11 hospital strategies analyzed individually, 3 strategies were independently associated with shorter treatment times. These included rapid triage/stroke-team notification (209/304 hospitals [69 percent], corresponding to an 8.1-minute reduction in treatment time), single-call activation system (190/304 hospitals [63 percent], 4.3-minute reduction), and tPA stored in the emergency department (189/304 hospitals [62 percent], 3.5-minute reduction). When analyzed incrementally, hospitals that used multiple strategies had shorter treatment times, with 1.3 minutes (adjusted mean difference) saved for each strategy implemented (14 minutes if all strategies were used).

Although the majority of participating hospitals reported using some strategy to reduce delays in tPA administration for acute ischemic stroke, the researchers discovered, the strategies applied varied considerably and those most strongly associated with shorter treatment times were applied relatively less frequently.