Men are twice as likely to receive brain-saving clot-busting medication within 30 minutes of arrival at the hospital, a new study shows.
Strokes are a medical emergency that occur when a person suddenly loses circulation to an area of the brain.
The most common kind of stroke occurs when a blood clot or other substance prevents blood from flowing through an artery to the brain. These are commonly called “dry strokes” because blood flow to the brain is restricted. These are also known as ischemic strokes. This type of stroke accounts for almost 90% of all strokes.
When it comes to the treatment of stroke, every minute counts. As time ticks away, critical brain tissue dies because of a lack of oxygenated blood. Timing of treatment is so essential that neurologists who treat strokes commonly use the phrase, “time lost is brain lost.”
Women Often Get Delayed Stroke Treatment
A new study reports, however, that male stroke patients are more than twice as likely as female patients to receive the critical clot-busting medication called tPA within thirty minutes of arrival at the hospital.
As the name signifies, clot-busting medication dissolves blood clots and allows blood flow to be restored to the brain. Clot-busting medication should be given as soon as possible. As each minute passes, the effectiveness of clot-busting medication decreases.
Early Stroke Treatment Is Best for All Patients
To have any affect at all, clot-busting medication needs to be given within 4.5 hours from the onset of symptoms.
The standard of care for doctors in the hospital is to give tPA when patients are experiencing symptoms of an ischemic stroke unless there is a good reason not to give the medication. The default is to give the medication within 30-60 minutes of arrival at the hospital.
Studies have shown that for every 15-minute delay in giving tPA, the chances of a successful outcome decreases. The best chance of recovery is to get “ultrafast” treatment, which is clot-busting medication within less than 30 minutes.
The most recent studies show that people who get tPA before they arrive at the hospital do even better. How could a patient get tPA before they arrive at a hospital? Patients are sometimes transported on “mobile stroke units.” These are ambulances specially equipped to diagnose and treat stroke while on the way to the hospital.
According to a study by researchers at the University of California Los Angeles, patients transported in a “mobile stroke unit” had a lower risk of stroke-related disability than people who received tPA at the hospital.
The research team was led by Dr. May Nour. The team compared 305 patients given tPA in a mobile stroke unit with 353 patients who got tPA after they arrived at the hospital.
The researchers concluded that for every 1,000 stroke patients given tPA on their way to the hospital, 182 will be less disabled by their stroke and 58 will have no disability at all.
Women Are More Likely to Get Delayed tPA Treatment than Men
In a recent study, a research team lead by Dr. Architt Bhatt evaluated nearly 2,700 stroke patients treated at one of 26 hospitals in the Pacific Northwest between 2009 and 2015.
Only about 4 percent of patients had tPA treatment times under a half hour.
Three factors appeared to make a difference in whether or not stroke patients received ultrafast treatment:
- Men were 2.2 times more likely than women to get ultrafast treatment.
- People arriving by ambulance were 4.7 times more likely to get the fast treatment than stroke patients driven to the hospital.
- Weekday arrivals were nearly twice as likely as those arriving during the evening or weekends to get ultrafast treatment.
Why are patients arriving by ambulance getting faster treatment than patients who arrive by private automobile?
The answer to this question is fairly obvious. Paramedics are trained to identify signs of stroke. Those same paramedics are trained to communicate with hospitals in order to initiate stroke protocols. When stroke protocols are initiated, specialists should be available as soon as the patient hits the doors.
This reinforces the directive that patients should immediately call 911 if they are experiencing signs of a stroke.
Why do stroke victims receive faster care on weekdays than other times?
The answer to that question is also straightforward. There are usually fewer patients in emergency rooms on weekdays. When hospitals are better staffed, with more doctors and fewer patients, patients get better care.
Doctors and other staff members have better time to plan ahead and give better care.
Why are men getting faster care than women?
The disparity in treatment time between men and women is more difficult to explain. In fact, there may not be a good explanation at all.
There is nothing obvious to demonstrate why women are being subjected to delays in stroke treatment. For example, the researchers found that men and women were equally likely to arrive on an ambulance. So, they both would have had the same chance of paramedics calling ahead to alert the hospital about stroke protocols. And, men are no more likely to have a stroke on a week day than women are.
Also, before getting the clot-busting medication tPA, patients need to receive imaging studies of their brain. This is needed to confirm that they are having the type of stroke that can be treated by the medication. But men and women are getting these brain imaging studies at the same rate.
The researchers found nothing measurable to confirm the disparity in treatment.
Some researchers have speculated that the disparity in treatment lies not in who is having the stroke, but who is providing the history of symptoms to doctors. Some researchers have ventured that when men are having strokes, it is often wives who are giving the history. Wives may be better at detecting stroke and advocating for better and faster care.
Some recent studies have shown that women may have atypical stroke symptoms. In addition, many women have strokes at an advanced age, and doctors can be reluctant to administer tPA to elderly people over fear of side effects.
Regardless of who is having a stroke, any delay in stroke diagnosis or treatment can have permanent consequences for the patient.
Experts recommend the F.A.S.T. guidelines for recognizing a stroke: Face drooping, Arm weakness or Speech difficulty means Time to call 911.
Studies Find That Not Enough Patients Get Clot-Busting Medication
While women may get slower treatment than men, additional studies report that overall stroke victims do not get clot-busting medication as often as they should.
Research has shown that certain groups of patients—in fact, everyone except white men—do not get clot-busting medication quickly enough.
According to a recent study by led by Tracy Madsen of Brown University’s Warren Alpert Medical School in Providence, R.I., Blacks, Hispanics, women, seniors on Medicare and people in rural areas are less likely to be treated with tissue plasminogen activator (tPA) after suffering a stroke, researchers found.
The study reviewed the records of more than 563,000 patients who suffered an ischemic stroke between 2005 and 2011. Across the entire period of time only 3.8 percent of total patients got the clot-busting drug, researchers reported.
The team found certain types of patients were less likely to receive tPA:
- Blacks were 38 percent less likely than whites.
- Hispanics were 25 percent less likely than whites.
- Women were 6 percent less likely than men.
- People with private insurance were 29 percent more likely to receive tPA compared to those on Medicare.
- People living in the so-called “Stroke Belt” in the southeastern United States were 31 percent less likely than those living elsewhere to receive tPA.
There are many factors that may decrease minority’s access to adequate medical care for stroke including lack of insurance, lack of transportation, decreased knowledge of stroke risk factors and symptoms, and language barriers. Click here for more information about minorities and stroke.
According to scholars,”[t]here’s been a long history of these groups being treated less aggressively for stroke.” Because of the importance of prompt stroke treatment, any delay in diagnosis or treatment may be a sign of medical malpractice.
Michael A. Hill is an accomplished trial lawyer focusing on representing individuals who have suffered life changing injuries, including stroke and death. Michael practices in state and federal courts around the country and has argued cases in front of numerous appellate courts, including the Ohio Supreme Court. Michael has recorded several seven figure verdicts and settlements. Michael is a regular speaker for lawyers concerning litigation and trial practice. Michael is a member of The National Trial Lawyers Top 40 under 40, Top 10 Nursing Homes Lawyers, Top 25 Medical Malpractice Lawyers, Super Lawyers: Rising Star, and Multi-Million Dollar Advocates Forum.
Michael is from Flint, Michigan and received his undergraduate degree from Oberlin College in Oberlin, Ohio, where he was introduced to his wife, Hilary. Michael received his law degree from Case Western Reserve University School of Law where he graduated Magna Cum Laude. Michael and Hilary live in Lakewood, Ohio. Michael is a Partner at Eadie Hill Trial Lawyers.