The Effect of TPA on In-Hospital Mortality in Patients Hospitalized with Ischemic Stroke in Florida from 2008-2012


Ischemic Stroke
Hospital Mortality


How to Cite

Bin Shihah AS, Al Rushud AF, Aldaham SA. The Effect of TPA on In-Hospital Mortality in Patients Hospitalized with Ischemic Stroke in Florida from 2008-2012. Integr J Med Sci [Internet]. 2017 Feb. 3 [cited 2024 May 30];4. Available from:


Introduction. In the U.S., tissue Plasminogen Activator (tPA) is the only approved thrombolytic drug to re-canalize occluded arteries in patients with acute ischemic stroke (AIS). With timely administration, tPA may improve the patient's prognosis. The percentage of AIS patients that receive tPA in the U.S., however, varies from 3.0% to 8.5%. Further, there is scarce information on the impact of tPA and short-term mortality among Floridians hospitalized with AIS. This study investigates factors associated with in-hospital mortality among patients admitted to Florida hospitals with AIS who received tPA compared to those who did not receive the thrombolytic.
Methods. This is a secondary analysis of the Florida Stroke Registry for 2008-2012. We assessed the association between tPA administration and in-hospital mortality utilizing logistic regression to estimate unadjusted and adjusted odds ratios. Pearson correlation coefficients were used to diagnose collinearity.
Results. A total of 133,052 ischemic stroke patients (51.9% women, average age 71.7±14.4 years) comprised our study sample. Approximately 5% (6,357) of AIS patients received tPA. After adjusting for potential confounders, AIS patients who received tPA were twice as likely to die than AIS patients not receiving tPA (OR=2.0; 95% CI= 1.8-2.2). AIS patients 90 years or older were five times more likely to die than AIS patients < 60 years (OR=5.0; 95% CI 4.4-5.7). Women were less likely to die compared to men (OR=0.9; 95% CI=0.87-0.99). Factors significantly increasing the likelihood of in-hospital mortality among AIS patients receiving tPA included being admitted to teaching hospitals (OR=1.6, 95% CI=1.5-1.7), lack of health insurance coverage (OR=2.0, 95% CI=1.8-2.3), extended hospitalization length of stay > 6 days (OR=1.2, 95% CI= 1.1-1.2), and not being assigned emergent priority at admission (OR=2.7, 95% CI= 2.5-2.9).
Conclusion. Our findings suggest that the likelihood of in-hospital mortality among Floridian patients with AIS is twice as higher among those receiving tPA than those AIS patients not receiving the thrombolytic. Increasing age, being a man and admitted to a teaching hospital, lack of health insurance, extended length of stay, and not receiving emergent priority at admission also increased the likelihood of in-hospital death for AIS patients after receiving tPA.


Stroke Facts. Centers for Disease Control and Prevention. [Accessed 25 June 2021]. Available from:

Dorado L, Millán M, Dávalos A. Reperfusion therapies for acute ischemic stroke: an update. Curr Cardiol Rev. 2014 Nov; 10:327-335.

Zangerle A, Kiechl S, Spiegel M, Furtner M, Knoflach M, Werner P, et al. Recanalization after thrombolysis in stroke patients: predictors and prognostic implications. Neurology. 2007 Jan 2; 68(1):39-44.

Jauch EC, Saver JL, Adams HP Jr, Buno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Mar;44(3):870-947.

Reeves MJ, Arora S, Broderick JP, Frankel M, Heinrich JP, Hickenbottom S, et al. Acute stroke care in the US: results from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry. Stroke. 2005;36(6):1232-40.

Katzan IL, Furlan AJ, Lloyd LE, Frank JI, Harper DL, Hinchey JA, et al. Use of tissue type plasminogen activator for acute ischemic stroke: the Cleveland experience. JAMA. 2000 Mar 1; 283(9):1151-1158.

Reed SD, Cramer SC, Blough DK, Meyer K, Jarvik JG. Treatment With Tissue Plasminogen Activator and Inpatient Mortality Rates for Patients With Ischemic Stroke Treated in Community Hospitals. Stroke. 2001 Aug;32(8):1832-40.

Heuschmann PU, Berger K, Misselwitz B, Hermanek P, Leffmann C,Adelmann M, et al. Frequency of thrombolytic therapy in patients with acute ischemic stroke and the risk of in-hospital mortality: the German Stroke Registers Study Group. Stroke. 2003 May;34(5):1106-13.

Heuschmann PU, Kolominsky-Rabas PL, Roether J, Misselwitz B, Lowitzsch K, Heidrich J, et al. Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy. JAMA. 2004 Oct 20; 292(15):1831-8.

Tanne D, Gorman MJ, Bates VE, Kasner SE, Scott P, Verro P, et al. Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in Patients Aged 80 Years and Older: the tPA stroke survey experience Stroke. 2000 Feb; 31(2):330-5.

Gillum LA, Johnston CS. Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes. Stroke. 2001 Sep;32(9):2137-42.

Bradbury RC, Golec JH , Steen PM. Comparing uninsured and privately insured hospital patients: admission severity, health outcomes and resource use. Health Serv Manage Res. 2001 Aug;14(3):203-10.

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Copyright (c) 2017 Abdulelah Saleh Bin Shihah et al.


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