IV tissue plasminogen activator for stroke in the community: what we know and don’t know 10 years after FDA approval

acute stroke across a wide range of community hospitals. It is important to note that this was a 20 % random sample from NIS and that the ICD 99.10 thrombolysis code is only 50% sensitive for identifying thrombolysis patients. Also, signifi-cant variables including baseline stroke severity, neuroimag-ing data, stroke etiologies, and hospital transfer patterns, as well as 90 day functional outcomes, are not available, which severely limits the conclusions which can be drawn from the database. Thus, although this is the largest “snapshot ” we have for IV tPA use in the United States 5 years after FDA approval, the picture remains blurred. Even allowing for coding inaccuracies, the rate of IV tPA use was distressingly low (2594/250 0051%). Clinical trials have repeatedly shown that late arrival to hospital and minor or improving neurological deficit are the main reasons pa