Abstract TMP84: Substantial Rise in tPA Utilization for Acute Ischemic Stroke in the United States Corresponds with Significant Improvement in Outcomes

Abstract

Background: Tissue plasminogen activator (tPA) is known to improve outcomes in Acute Ischemic stroke (AIS). Earlier studies showed low tPA utilization rates (1-4%) in AIS, ~6% hemorrhagic conversion (HC) with tPA and ~50% mortality in those who had HC. Results from interval studies and enhanced stroke systems of care have likely led to higher tPA utilization in recent times. Objective: To assess real-world trends in tPA utilization in AIS, and corresponding clinical outcomes in the United States. Methods: Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample database was reviewed from 2002 to 2014. Hospitalizations with AIS were identified using ICD-9-CM codes 433.xx-436, tPA use by procedure code 99.10 and post tPA and HC with ICD-9 431 as secondary diagnosis. Cochran Armitage trend test and survey logistic regression procedure were used to analyze trends and outcomes. Results: Of 5,577,707 hospitalizations with diagnosis of AIS, 264,643 (4.74%) received tPA. There is an ~950% increase in tPA utilization in AIS from 2002 to 2014 (Table). In-patient mortality in tPA group has been reduced by ~50%, with 35% increase in discharge to home. There was an ~80% increase in hemorrhagic conversion in tPA group (5.15% to 9.47%; p<0.001). Although HC increased, there was a ~60% decrease in in-patient mortality and ~60% increase in discharge to home among HC. Conclusions: Over the last decade, there was a substantial increase in tPA utilization for AIS in the United States. HC remains a major concern, however outcomes in those with HC were remarkably better than perceived earlier. Though enhanced stroke systems of care may be a confounding factor, decreased mortality and improved functional outcomes should drive the treating physicians to be aggressive with tPA utilization in AIS.