Abstract 2905: Changes Of Systemic Thrombolysis Rates In A Large Hospital-based Stroke Registry

Abstract

Objectives: This analysis determines changes in systemic thrombolysis rates in a large state-wide stroke data set covering an observation period of 7 years following the approval of rtPA therapy in Germany. Methods: A prospective hospital-based stroke registry covering the entire Federal State of Hesse, Germany was analyzed. All patients admitted between 2003 and 2009 with a final diagnosis of ischemic stroke (ICD-10: I63) were selected. The relationship between thrombolysis rates, onset-to-admission time, patient age, and initial stroke severity (assessed by the Modified Rankin Scale (MRS)) was analyzed. One-way ANOVA was performed to test for significant changes during the observation period. Results: We identified 88.340 patients with ischemic stroke. Thrombolysis rates increased continuously from 2.5% in 2003 to 8.4% in 2009. In patients admitted within 3h after symptom onset, thrombolysis rate was 2.5 fold higher in 2009 (25.4%) as compared to 2003 (10.5%). Mean age (+/-SD) of thrombolyzed patients increased from 68.7 (+/-11.5) years in 2003 to 70.7 (+/-13.4) years in 2009 (p=0.014 for trend), but remained stable in the entire cohort. In contrast, stroke severity decreased both in rtPA treated patients (initial mean MRS score 3.9 in 2003 and 3.5 in 2009 (p<0.001 for trend)), and in the entire cohort (3.1 (2003); 2.9 (2009), p<0.001 for trend). Conclusions: Thrombolytic therapy is increasingly used in acute ischemic stroke, particularly in patients admitted within the 3h time window. Several factors as improved clinical pathways, increasing personal experience and financial incentives may contribute to this development. In addition, our data suggest that higher treatment rates are at least partially explained by spreading rtPA application towards older and less severely affected patients.