Lifesaving treatment administered to only 10% of eligible stroke patients

Two decades after being approved by the FDA for treatment of acute ischemic stroke, clot-dissolving medication intravenous alteplase is administered to just 10 percent of eligible patients, researchers from Georgia State recently reported in the American Journal of Emergency Medicine.

Intravenous (IV) alteplase was tested and approved in 1996, and has since been shown to reduce disability and improve functionality in stroke patients, according to the research. By restoring blood flow to the brain, IV alteplase can be a lifesaver for patients with a low likelihood of surviving an ischemic stroke and can reduce long-term mortality in those individuals.

Lead author Moges S. Ido, MD, MS, MPH, PhD, and colleagues examined the medical data of 9,620 patients enrolled in the Georgia Coverdell Acute Stroke Registry and examined the information against Georgia death and hospital discharge data. They ultimately found that patients who didn’t receive IV alteplase following a stroke were 49 percent more likely to die than those who did receive the treatment.

Ido said in a release from Georgia State doctors often avoid treating stroke patients with IV alteplase because of its possible adverse side effects.

“Clinicians may be hesitant to administer IV alteplase because of concerns about the drug’s complications, which can include bleeding,” he said. “But this study indicates that unless major contraindications are present, patients should be offered this treatment as a life-saving measure.”

Major contraindications, he said, could include medical procedures like recent brain surgery. Of the nearly ten thousand patients reviewed in their study, the researchers identified a handful of subjects who weren’t eligible for IV alteplase treatment due to such contraindications. Still, of the eligible patients, only a quarter actually received the treatment.

More than 20 percent of acute ischemic stroke patients included in the study died within a year, and 22.4 percent were readmitted to a hospital, Ido and colleagues wrote. Individuals who didn’t receive IV alteplase had nearly 1.5 times higher odds of dying within a year of their stroke compared to patients treated with IV alteplase.

“After accounting for patient differences and missing value, intravenous alteplase is associated with reduction in long-term mortality,” the authors wrote. “The results of this study suggest that patients who are identified as eligible for intravenous alteplase need to be offered the treatment.”