Stroke: Clot-busting drugs use rises, but more needed

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The number of acute ischemic stroke patients administered clot-busting drugs has doubled since 2005, from 3.4 to 5.2 percent in 2009. However, according to new research published in Stroke, the numbers of patients who receive thrombolytic drugs are still low.

Currently, recombinant tissue plasminogen activator (rt-PA) is the only therapy approved for acute ischemic stroke patients by the FDA and only 1 to 4 percent of the ischemic stroke population in the U.S. receives these drugs.

In the current analysis, Opeolu Adeoye, MD, of the University of Cincinnati in Ohio, and colleagues extracted 2005 and 2009 data from the MEDPAR database to study the trends of rt-PA use in the U.S. The researchers used both pharmacy billing codes (Premier database) and ICD-9 codes (MEDPAR database).

Within the MEDPAR database, thrombolytic use increased 28 percent annually, 1.1 percent in 2005 to 3.4 percent in 2009. Likewise, thrombolytic use increased 24 percent annually, 1.4 percent versus 3.7 percent, within the Premier database. In patients older than 65 years, rt-PA use increased from 1.2 percent to 3.4 percent, respectively. When patients with transient ischemic attack (TIA) or hemorrhagic stroke who received thrombolytic drugs were included the rate increased to 5.2 percent.

The researchers found that thrombolytic use was greater than Alteplase (50 mg or 100 mg vials) use.

The rate of clot-busting drugs use between 2005 and 2009 doubled. The researchers called these results “strikingly different” than previous analyses that showed no difference in rt-PA use between 2001 and 2004. In the current analysis the number of patients  administered thrombolytics increased from 3.4 percent to 5.2 percent, compared to 1.8 percent to 2.1 percent between 2001 and 2004.

Adeoye and colleagues noted the increased treatment rate could create a decline in stroke disability and morbidity over time. Additionally, the researchers noted that administering these types of drugs immediately, within the first hour, is most effective.

“A confluence of factors may account for the significantly increased rt-PA use for ischemic stroke in the U.S.,” the authors wrote. For example, the Centers for Medicare and Medicaid Services approved a new diagnosis related group (DRG) in October 2005. This code increased the hospital payments for acute stroke patients to $11,500 compared with previous DRG codes such as DRG 14 (intracranial hemorrhage or stroke with infarct) where hospital payments equated to $6,400.

These financial incentives in conjunction with the certification of primary stroke centers and the American Heart Association’s Get with the Guidelines campaign may have all led to the increased treatment rates with rt-PA.

“Notably, the increase in treatment rates began in FY2005, prior to approval of DRG 559, suggesting that higher reimbursement was not the primary factor driving increased treatment rates,” the authors wrote.

The fact that both the Premier and MEDPAR databases are determined by billing personnel and is prone to errors was a limitation to the analysis.

The authors concluded that “rapid recognition and transport, and quick treatment in the emergency department remain goals for further improving treatment rates.”