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Abstract Details

Reported Use of IV-Tissue Plasminogen Activator (IV-TPA) for Acute Ischemic Stroke (AIS) Worldwide: A Systematic Review
Cerebrovascular Disease and Interventional Neurology
S09 - (-)
002
IV-TPA is the most effective treatment for AIS. Multiple barriers exist to the use of IV-TPA, including drug cost and availability, rapid access to hospitals, neuroimaging infrastructure, and critical care.
A systematic review was performed for each country AND "stroke" OR "tissue plasminogen activator" OR "thrombolysis" in PubMed (published Jan.1,1997-Oct.1,2012). Each country's literature was reviewed separately by 2 reviewers, and the level of study quality, published in any language, was determined. Country income status was determined by the World Bank (2011) and total expenditure on health per capita by the World Health Organization (2010).
Of 214 countries and independent territories, 54 (25%) reported use of IV-TPA for AIS, including 3% (1/36) of low-income, 13% (7/54) of lower middle-income, 28% (15/54) of upper middle- income, and 44% (31/70) of high-income countries (p<0.0001). Among reporting countries, the highest quality study was original hypothesis-driven research in 69% (n=37), case series in 26% (n=14), and case report in 6% (n=3). The median total health care expenditure per capita was higher among countries using vs. not using IV-TPA for AIS (1514 vs. 302 international dollars, p<0.0001), including within the higher income country groups (high income countries: 3361 vs. 1678, p=0.002, upper middle income countries: 998 vs. 624, p=0.01). This was not found in lower income country strata (lower middle income countries: 132 vs. 229, p=0.03, low income countries: 78 vs. 64, p=0.664).
IV-TPA for AIS has limited reported use globally, available to patients in only one-quarter of countries. Barriers to IV-TPA use for countries at different income levels must be understood and overcome. Research and development for less expensive, more accessible treatments for AIS in developing countries are imperative.
Authors/Disclosures
Manoj Mittal, MD (Sutter Medical Center, Sacramento)
PRESENTER 		Dr. Mittal has nothing to disclose.
Aaron L. Berkowitz, MD, PhD, FAAN Dr. Berkowitz has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. Dr. Berkowitz has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for McGraw-Hill 好色先生. Dr. Berkowitz has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received personal compensation in the range of $500-$4,999 for serving as a Content creator with Clinical problem Solvers. Dr. Berkowitz has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant with Thieme Publisher.
Hannah C. McLane, MD, MPH (University of Pennsylvania) No disclosure on file
No disclosure on file
No disclosure on file
Rajanandini Muralidharan, MD, FAAN (Winthrop Neuroscience) Dr. Muralidharan has nothing to disclose.
Jennifer Lyons, MD (Brigham and Women's Hospital) Dr. Lyons has received personal compensation for serving as an employee of Biogen. Dr. Lyons has received stock or an ownership interest from Biogen.
Russell T. Shinohara Mr. Shinohara has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association. The institution of Mr. Shinohara has received research support from National Institutes of Health. The institution of Mr. Shinohara has received research support from National Multiple Sclerosis Society.
Ashfaq Shuaib, MD (Div of Neurology) Dr. Shuaib has nothing to disclose.
Farrah J. Mateen, MD, PhD, FAAN (Massachusetts General Hospital) Dr. Mateen has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics (Amgen). Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology. The institution of Dr. Mateen has received research support from Genentech. The institution of Dr. Mateen has received research support from EMD Serono. The institution of Dr. Mateen has received research support from Novartis. The institution of Dr. Mateen has received research support from Horizon Therapeutics (Amgen). The institution of Dr. Mateen has received research support from TG Therapeutics. Dr. Mateen has received intellectual property interests from a discovery or technology relating to health care.