Utilization of intravenous tissue-type plasminogen activator for ischemic stroke at academic medical centers - The influence of ethnicity
Utilization of intravenous tissue-type plasminogen activator for ischemic stroke at academic medical centers - The influence of ethnicity
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DOI：
10.1161/01.str.32.5.1061
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发表时间：
2001-05-01
期刊：
影响因子：
8.3
通讯作者：
Brown, AN
中科院分区：
文献类型：
--
作者：
Johnston, SC;Fung, LH;Brown, AN
背景和目的：我们试图测量学术医疗中心组织型纤溶酶原激活剂（tPA）治疗缺血性卒中的总体使用率，并确定种族是否与使用相关。方法：1999年6月至12月，美国42个学术医疗中心分别确定了30例连续的缺血性中风病例。对1195例缺血性脑卒中患者的医疗记录进行回顾，提取其人口统计学、病史和治疗信息，通过单因素分析比较非裔美国人和白人患者tPA的使用情况，并通过多变量logistic回归对年龄、性别、卒中严重程度和医疗保险类型进行调整。788人是白人，285人是非裔美国人。总的来说，49例患者（4.1%）接受了tPA，在189例无治疗禁忌症的患者亚组中，39例（20.6%）接受了tPA。接受tPA治疗的患者中有10人（20%）有记录的禁忌症。非裔美国人接受tPA的可能性是白人的五分之一（1.1%非裔美国人对5.3%；P=0.001），调整后差异仍然存在（OR 0.21, 95% CI 0.06至0.68；P=0.01），当比较限于无tPA禁忌症的患者时，差异仍然显著（OR 0.24, 95% CI 0.06至0.93；P=0.04）。医疗保险类型与tPA治疗独立相关。在调整种族和其他人口统计学特征后，那些有医疗补助或没有保险的人接受tPA的可能性是那些有私人医疗保险的人的九分之一（or 0.11, 95% CI 0.02至0.17；P=0.003）。结论：在美国学术医疗中心，tpa很少用于缺血性卒中，即使在合格的候选人中也是如此。非裔美国人接受tPA治疗缺血性中风的可能性明显较低。治疗的禁忌症似乎不能解释这种差异。
Background and Purpose-We sought to measure the overall rate of usage of tissue-type plasminogen activator (tPA) for ischemic stroke at academic medical centers, and to determine whether ethnicity was associated with usage.Methods-Between June and December 1999, 42 academic medical centers in the United States each identified 30 consecutive ischemic stroke cases. Medical records were reviewed and information on demographics, medical history, and treatment were abstracted, Rates of tPA use were compared for African Americans and whites in univariate analysis and after adjustment for age, gender, stroke severity, and type of medical insurance with multivariable logistic regression,Results-Complete information was available for 1195 ischemic stroke patients; 788 were whites and 285 were African Americans. Overall, 49 patients (4.1%) received tPA, In the subgroup of 189 patients without a documented contraindication to therapy, 39 (20.6%) received tPA. Ten (20%) of those receiving tPA had documented contraindication. African Americans were one fifth as likely to receive tPA as whites (1.1% African Americans versus 5.3%; P=0.001), and the difference persisted after adjustment (OR 0.21, 95% CI 0.06 to 0.68; P=0.01), When comparison was restricted to those without a documented contraindication to tPA, the difference remained significant (OR 0.24, 95% CI 0.06 to 0.93; P=0.04). Medical insurance type was independently associated with tPA treatment. After adjustment for ethnicity and other demographic characteristics, those with Medicaid or no insurance were one ninth as likely to receive tPA as those with private medical insurance (OR 0.11, 95% CI 0.02 to 0.17; P=0.003).Conclusions-tPA is used infrequently for ischemic stroke at US academic medical centers, even among qualifying candidates. African Americans are significantly less likely to receive tPA for ischemic stroke. Contraindications to treatment do not appear to account for the difference.