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Emerging temporal trends in tissue plasminogen activator use: Results from the BASIC project.

Joseph S Domino1, Jonggyu Baek1, William J Meurer1

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Tissue plasminogen activator (tPA) use for acute ischemic stroke (AIS) increased significantly in a community without an academic center, particularly for severe strokes. However, disparities in tPA administration between Mexican Americans and non-Hispanic whites emerged.

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Area of Science:

  • Neurology
  • Public Health
  • Stroke Medicine

Background:

  • Acute ischemic stroke (AIS) treatment relies on timely administration of tissue plasminogen activator (tPA).
  • Understanding temporal trends in tPA use is crucial for optimizing stroke care, especially in diverse communities.
  • Population-based surveillance provides valuable insights into real-world treatment patterns.

Purpose of the Study:

  • To examine temporal trends in tPA administration for AIS.
  • To investigate variations in tPA use based on age, sex, ethnicity, and stroke severity.
  • To assess tPA trends in a biethnic community without an academic medical center.

Main Methods:

  • Utilized data from the Brain Attack Surveillance in Corpus Christi (BASIC) project (2000-2012).
  • Identified 5,277 AIS cases from 4,589 individuals across 7 hospitals.
  • Employed generalized estimating equations to analyze temporal trends, adjusting for covariates and testing for effect modification.

Main Results:

  • tPA use remained stable at 2% until 2006, then increased to 11%.
  • Stroke severity significantly modified temporal trends; higher NIHSS scores correlated with greater increases in tPA use.
  • Mexican Americans (MAs) showed a trend of lower tPA receipt compared to non-Hispanic whites (NHWs) in later years.

Conclusions:

  • Significant increases in tPA administration were observed in this community, likely influenced by primary stroke center certification.
  • Treatment intensification for severe AIS cases was evident.
  • An emerging disparity in tPA use between Mexican Americans and non-Hispanic whites warrants further investigation.