The study aims to explore the temporal trend and its relationship between race or ethnicity disparities regarding the administration of intravenous thrombolysis among clinically indicated patients with acute ischemic stroke in Arkansas.

Intravenous thrombolysis with alteplase, a recombinant tissue plasminogen activator, is the mainstay of reperfusion therapy for adult patients presenting with acute ischemic stroke. However, it remains unclear whether the temporal evolution and population distribution by race or ethnicity would impact the provision of this standard-of-care.

We conducted a retrospective study on patients presenting to the partnering hospitals of the AR SAVES (Arkansas Stroke Assistance through Virtual Emergency Support) program with a diagnosis of acute ischemic stroke causing measurable neurologic deficit. Racial and ethnic composition was retrieved from the United States Census Bureau report and categorized into four groups: (1) white; (2) black or African American; (3) Hispanic or Latino; and (4) Asian. We assessed the trend of alteplase administration among all stroke referrals (available from 2013 to 2017) and its association with population composition (available from 2015 to 2017). Statistical significance was set at a two-tailed alpha level of 0.05.

Among the total population in Arkansas, 77.0% were white, 15.4% black, 6.4% Hispanic, and 1.2% Asian. Among the stroke referrals to AR-SAVES, the percentage of alteplase provision increased from 25.4% (151/594) in 2013 to 33.2% (274/826) in 2017 (P for trend=0.006). Race disparities were consistently observed among reperfused patients in 2015 (88.2% [white] vs 9.7% [black] vs 1.7% [Hispanic] vs 0.4% [Asian]), 2016 (88.2% vs 10.6% vs 0.8% vs 0.4%), and 2017 (91.5% vs 7.9% vs 0.6% vs 0.0%), without a significant variation across the past three years (P=0.53).

Data from the AR SAVES network indicate that the administration of intravenous thrombolysis for ischemic stroke significantly increased from 2013 to 2017 while race disparities were consistently observed.