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Thrombolytic use more than doubled during 5-year interval
Adeoye O. Stroke. 2011;doi:10.1161/strokeaha.110.612358.
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Use of recombinant tissue-type plasminogen activator, the only FDA-approved therapy for acute ischemic stroke, increased two- to threefold from 2005 to 2009, according to an analysis published in Stroke.
“This is strikingly different from our previous report, which found essentially no difference in recombinant tissue-type plasminogen activator treatment rates between 2001 and 2004,” the researchers wrote.
Researchers identified patients using thrombolytics via Medicare records and pharmaceutical billing codes (Premier databases) to generate the current finding. They determined acute ischemic stroke through the exclusion of hemorrhagic stroke and transient ischemic attack from diagnosis-related groups (DRG) 14, 15, 524 and 559 discharges.
From 2005 and 2009, thrombolytic use as determined by Medicare records rose from 1.1% to 3.4%, whereas within Premier, it increased from 1.4% to 3.7% (P<.001 for both trends). Further analysis into Premier regarding 50-mg and 100-mg doses of recombinant tissue-type plasminogen activator therapy revealed that 3.4% of acute ischemic stroke cases were treated in 2009.
A possible explanation for the rise in use, according to researchers, was the approval of DRG 559 in 2005, which increased the payment to hospitals for acute stroke patients to $11,500 compared with $6,400 for DRG 14 and $4,900 for DRG 15. Added to which, they said, were the establishment of formal certification of primary stroke centers by the Joint Commission, the various statewide initiatives to standardize acute stroke care and the American Heart Association’s “Get with the Guidelines” campaign.
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