There are two types of strokes, an ischemic stroke and hemorrhagic one. Hemorrhagic strokes are caused by a blood vessel that has broken open, creating a rupture, and is treated by stopping the bleeding. In contrast, majority of the strokes are ischemic or when there is a blood clot in a vessel that goes to the brain. These are treated by removing the clot with medication such as tissue plasminogen activator (tPA was approved by the FDA in 1996).
tPA, or Alteplase is administered via IV through the arm and works to dissolve a clot and improve blood flow after a CT or MRI. This form of treatment must be given within 3-4.5 hours in eligible patients, and often times, has full recovery in many patients. Often times, the administration of tPA may prevent 1 out of 6 patients from death or long term disabilities and other brain injuries.
So what's the problem with this drug you ask? Recent studies conducted by Dr. Archit Bhatt and colleagues at the Providence Brain and Spine Institute identified three factors that affected disparities amongst patients who were able to receive ultrafast door-to-needle times. Of the three are arrival time, day, and surprisingly, sex. Men were 2.2 times more likely to receive this treatment compared to women. These staggering results prompt me to ask why these disparities exist.
Similar results were observed by Dr. Tracy Madsen at Brown's Warren Alpert Medical School, where of 563,087 stroke patients from 2005-2011, only 3.8% had received tPA. What appears to be even more appalling was the fact that there were racial as well as gender biases in concerns to the receiving of tPA. Moreover, the type of insurance seemed to play a role in treatment, since 29% private insurance holders were more likely to receive this drug compared to those on Medicare, even though treating stroke patients with tPA may save payers $25,000 per patient in a lifetime. Certainly, more research needs to be conducted on the reasoning, both economical and social, behind why more people who need this form of treatment and are within the 3 hour time slot are not in fact receiving.
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