Factors Associated with the Administration of Tissue Plasminogen Activator for Acute Ischemic Stroke

Background: The use of intravenous tissue plasminogen activator (t-PA) can be an effective treatment for acute ischemic stroke if administered promptly. Despite its clinical effectiveness, overall use in Japan remains low, and regional variations have been reported. Factors such as ambulance utilization and geographical distance from patients' residences to hospitals may influence t-PA administration rates. The aim of this study is to identify factors associated with the administration of t-PA for acute ischemic stroke while adjusting for casemix using a large-scale administrative database in Japan. Methods: We analyzed acute ischemic stroke patients admitted to acute care hospitals between July 2010 and March 2011 using a nationwide database. A logistic regression model was used to analyze the factors influencing t-PA administration. Candidate factors included patient gender, age, stroke severity, direct distance between each patient's residence and admitting hospital, and ambulance utilization. Results: Of the 10,615 ischemic stroke patients from 89 hospitals analyzed, 557 (5.2%) received t-PA treatment. Patients aged 75 years and older were found to be associated with decreased t-PA administration. In contrast, severe stroke and ambulance utilization were associated with increased t-PA administration. Distance was not significantly associated with the use of t-PA. Conclusions: Our findings suggest that ambulance utilization is an important factor for improving the likelihood of t-PA administration in patients with stroke and may underline a need for educational programs to the general public that promote the use of ambulances for suspected stroke patients.