Neurology: Racial Differences in Thrombolysis Reduction Rates for Stroke: Among Non-Hispanic Patients, Asians Have Better tPA Rates than Whites, Blacks Least

The development of hospital-based quality improvement programs, such as the American Heart Association's Stroke Guidelines ( GWTG-Stroke) Program and Objective: Stroke Exercise, has resulted in appropriate and Timely intravenous injection of tissue plasminogen activator (tPA) improved
.

Despite these efforts, tPA treatment rates in AIS patients remain suboptimal, ranging from 3% to 7%, with lower rates in black patients

Stroke Guidelines acute ischemic stroke (AIS) tissue plasminogen activator (tPA)

Racial and ethnic disparities were observed in many aspects of stroke care, including prehospital care, acute treatment of tPA, and stroke outcomes
.

For example, non-Hispanic black patients were 20% less likely to arrive via emergency medical services (EMS) and less likely to achieve door-to-needle (DTN) times ≤60 minutes

Racial and ethnic disparities were observed in many aspects of stroke care, including prehospital care, acute treatment of tPA, and stroke outcomes

Recently, researchers used the Get With The Guidelines-Stroke registry to identify patients with AIS who were eligible for tPA and who were admitted to participating hospitals between January 1, 2016, and March 28, 2019

Researchers used the Get With The Guidelines-Stroke registry to identify tPA-eligible AIS patients admitted to participating hospitals between January 1, 2016, and March 28, 2019
.

The researchers compared patient demographics and admission characteristics between eligible patients who received tPA and those who refused tPA

Researchers used the Get With The Guidelines-Stroke registry to identify tPA-eligible AIS patients admitted to participating hospitals between January 1, 2016, and March 28, 2019

• Among 177,115 tPA-eligible acute ischemic stroke patients at 1,976 sites, 6,545 patients (3.
  7%) cited decreased tPA treatment rates as the only documented reason for not receiving tPA
  .
  
• Patients who refused treatment were slightly older, more likely to be female, arrived more often during "off-hours" and earlier after symptom onset, and were more likely to present to a primary stroke center
  .
  
• In multivariate analysis, non-Hispanic black race was independently associated with increases (aOR 1.
  21, 95% CI 1.
  11-1.
  31) and Asian race was independently associated with decreases (aOR 0.
  72, 95% CI 0.
  58-) compared with non-Hispanic whites 0.
  88), Hispanic (any race) was associated with similar odds of decreased tPA treatment rate (OR 0.
  98, 95% CI 0.
  86-1.
  13)
  .
  

Among 177,115 tPA-eligible acute ischemic stroke patients at 1,976 sites, 6,545 patients (3.
7%) cited decreased tPA treatment rates as the only documented reason for not receiving tPA
.

Treatment rates drop

Patients who refused treatment were slightly older, more likely to be female, arrived more often during "off-hours" and earlier after symptom onset, and were more likely to present to a primary stroke center
.

In multivariate analysis, non-Hispanic black race was independently associated with increases (aOR 1.
21, 95% CI 1.
11-1.
31) and Asian race was independently associated with decreases (aOR 0.
72, 95% CI 0.
58-) compared with non-Hispanic whites 0.
88), Hispanic (any race) was associated with similar odds of decreased tPA treatment rate (OR 0.
98, 95% CI 0.
86-1.
13)
.

    Although the overall prevalence of declining tPA treatment rates was low, eligible non-Hispanic black patients were more likely to have a reduced tPA treatment rate than non-Hispanic white patients, and Asian patients were more likely to have a reduced tPA treatment rate lower
.

Reducing tPA treatment rates in non-Hispanic black patients may be an opportunity to address disparities in stroke care

    Although the overall prevalence of declining tPA treatment rates was low, eligible non-Hispanic black patients were more likely to have a reduced tPA treatment rate than non-Hispanic white patients, and Asian patients were more likely to have a reduced tPA treatment rate lower

Mendelson SJ, Zhang S, Matsouaka R, et al.
Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke [published online ahead of print, 2022 Feb 28].
Neurology.
2022;10.
1212/WNL.
0000000000200138.
doi:10.
1212/ WNL.
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