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Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke.

Publication ,  Journal Article
Mendelson, SJ; Zhang, S; Matsouaka, R; Xian, Y; Shah, S; Lytle, BL; Solomon, N; Schwamm, LH; Smith, EE; Saver, JL; Fonarow, G; Holl, J; Prabhakaran, S
Published in: Neurology
April 19, 2022

BACKGROUND AND OBJECTIVES: Prior regional or single-center studies have noted that 4% to 7% of eligible patients with acute ischemic stroke (AIS) decline IV tissue plasminogen activator (tPA). We sought to determine the prevalence of tPA declination in a nationwide registry of patients with AIS and to investigate differences in declination by race/ethnicity. METHODS: We used the Get With The Guidelines-Stroke registry to identify patients with AIS eligible for tPA and admitted to participating hospitals between January 1, 2016, and March 28, 2019. We compared patient demographics and admitting hospital characteristics between tPA-eligible patients who received and those who declined tPA. Using multivariable logistic regression, we determined patient and hospital factors associated with tPA declination. RESULTS: Among 177,115 tPA-eligible patients with AIS at 1,976 sites, 6,545 patients (3.7%) had tPA declination as the sole documented reason for not receiving tPA. Patients declining treatment were slightly older, were more likely to be female, arrived more often at off-hours and earlier after symptom onset, and were more likely to present to Primary Stroke Centers. Compared with non-Hispanic White, non-Hispanic Black race/ethnicity was independently associated with increased (adjusted odds ratio [aOR] 1.21, 95% CI 1.11-1.31), Asian race/ethnicity with decreased (aOR 0.72, 95% CI 0.58-0.88), and Hispanic ethnicity (any race) with similar odds of tPA declination (OR 0.98, 95% CI 0.86-1.13) in multivariable analysis. DISCUSSION: Although the overall prevalence of tPA declination is low, eligible non-Hispanic Black patients are more likely and Asian patients less likely to decline tPA than non-Hispanic White patients. Reducing rates of tPA declinations among non-Hispanic Black patients may be an opportunity to address disparities in stroke care.

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Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

April 19, 2022

Volume

98

Issue

16

Start / End Page

e1596 / e1604

Location

United States

Related Subject Headings

  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Stroke
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Male
  • Ischemic Stroke
  • Humans
  • Fibrinolytic Agents
  • Female
 

Citation

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Mendelson, S. J., Zhang, S., Matsouaka, R., Xian, Y., Shah, S., Lytle, B. L., … Prabhakaran, S. (2022). Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke. Neurology, 98(16), e1596–e1604. https://doi.org/10.1212/WNL.0000000000200138
Mendelson, Scott J., Shuaiqi Zhang, Roland Matsouaka, Ying Xian, Shreyansh Shah, Barbara L. Lytle, Nicole Solomon, et al. “Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke.Neurology 98, no. 16 (April 19, 2022): e1596–1604. https://doi.org/10.1212/WNL.0000000000200138.
Mendelson SJ, Zhang S, Matsouaka R, Xian Y, Shah S, Lytle BL, et al. Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke. Neurology. 2022 Apr 19;98(16):e1596–604.
Mendelson, Scott J., et al. “Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke.Neurology, vol. 98, no. 16, Apr. 2022, pp. e1596–604. Pubmed, doi:10.1212/WNL.0000000000200138.
Mendelson SJ, Zhang S, Matsouaka R, Xian Y, Shah S, Lytle BL, Solomon N, Schwamm LH, Smith EE, Saver JL, Fonarow G, Holl J, Prabhakaran S. Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke. Neurology. 2022 Apr 19;98(16):e1596–e1604.

Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

April 19, 2022

Volume

98

Issue

16

Start / End Page

e1596 / e1604

Location

United States

Related Subject Headings

  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Stroke
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Male
  • Ischemic Stroke
  • Humans
  • Fibrinolytic Agents
  • Female