Initiatives needed to boost tPA use in Black stroke patients
MedWire News: Delayed presentation and contraindications are hampering efforts to provide intravenous tissue plasminogen activator (tPA) treatment to Black patients with stroke, shows research.
"Our findings highlight the complexity underlying racial treatment disparities and emphasize the importance of systemic changes when designing interventions that will affect public awareness and stroke knowledge, as well as hospitals in which underserved patients are more likely to receive their care," say Amie Hsia (Washington Hospital Center, District of Columbia, USA) and co-workers.
The team's study, which appears in the journal Stroke, covers 1044 stroke patients admitted to seven acute care hospitals in the District of Columbia over a 1-year period (2008-2009).
Almost three-quarters of the cohort were Black, and just 3% of these patients underwent thrombolysis, compared with 10% of the non-Hispanic Whites who formed the next largest racial group in the study cohort (19%).
This disparity was partly due to presentation delays, with only 13% of Black patients presenting within the 3-hour tPA treatment window, compared with 21% of White patients.
Disparities remained among patients who presented within the treatment window, with just 27% of Black patients undergoing thrombolysis versus 46% of White patients.
But this was due to a high rate of contraindications among Black patients, say Hsia et al. Just 5% of all Black patients were eligible to receive tPA, compared with 13% of White patients. Ethnicity did not significantly influence tPA treatment rates among patients who were eligible and presented early enough, at 70% and 76% for Black and White patients, respectively.
The most common contraindication in Black patients was that the time of symptom onset could not be established or that tPA could not be administered within 3 hours of onset. This affected about a quarter of Black patients, versus just 10% of White patients. Other contraindications that were more common in Black than White patients were having no neurologic deficit (19%), uncontrolled hypertension (7%), evidence of intracranial hemorrhage (4%), and seizure at stroke onset (3%).
The researchers say that possible interventions to counter the low thrombolysis rate in Black patients include "culturally relevant educational campaigns specifically designed to increase stroke recognition and preparedness for early arrival within this urban Black population and improved risk factor control to maximize eligibility."
They conclude: "These measures have the potential to increase the number of eligible patients and reduce disparities in both treatment rates and overall stroke outcomes."
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By Eleanor McDermid