Minorities and women suffering from a stroke may be less likely to receive the clot-busting treatment known as tissue plasminogen activator or tPA, according to a new study from Penn Medicine and other institutions published in the online issue of Neurology.

The elderly and those with milder stroke symptoms were also less likely to receive intravenous tPA, a drug which has been shown to significantly improve chances of cure from stroke disability, after arriving at a hospital.

Researchers conducted a retrospective study of over 61,000 ischemic stroke patients in the United States between 2003 and 2011 who arrived at a hospital within two hours after the start of symptoms and had no documented reasons that they could not receive the treatment.

Overall, they found that 25% of the eligible stroke patients did not receive the treatment. Treatment rates did, however, improve dramatically over time. From 2003 to 2004, 45% of eligible patients received treatment compared to 82% from 2010 to 2011. 

After adjusting for hospital and patient factors, including stroke severity, women had 8% greater odds of not receiving treatment than men. African-Americans had 26% greater odds of not receiving treatment than whites, while those of other races had17% greater odds of not receiving treatment than whites.

Additional patient-specific factors associated with non-treatment included history of carotid stenosis, peripheral vascular disease, diabetes mellitus, heart attacks, presence of a prosthetic heart valve and not presenting to the hospital via EMS. 

The researchers also found, as did previous reports, that people who were treated at hospitals certified as stroke centers were more likely to receive treatment than those at hospitals without the certification, with those at primary stroke centers having nearly twice the odds of receiving tPA. Patients not treated with tPA presented to hospitals that had a smaller number of beds, were less often teaching hospitals or Joint Commission–certified primary stroke centers, and had fewer annual ischemic stroke admissions, the authors found.

 “To improve use of the clot-busting medication, patients and families should be educated about potential stroke symptoms and encouraged to call EMS if stroke is suspected. Continued development of systems of care for stroke should remain a high priority, as well,” Steven R. Messé, first author and associate professor in the division of vascular neurology at the Perelman School of Medicine at Penn, said. “Additional studies should also be taken to address the potential disparities in care for patients with ischemic stroke.”