More Aggressive Treatment for Weekend Stroke

Stroke victims brought to a hospital on a weekend are more likely to receive tissue plasminogen activator (tPA) than those who arrive on a weekday, a study finds. The findings were published in the Archives of Neurology.

It's an unexpected finding, since the study was triggered by a previous report showing that aggressive treatment for heart attacks was more likely to be given during the week rather than the weekend, noted study lead author Abby S. Kazley, PhD, an assistant professor of health administration and policy at the Medical University of South Carolina.

The heart attack study sent Kazley and her colleagues searching through the records of almost 79,000 people admitted to Virginia hospitals between 1998 and 2006 with ischemic strokes, in which a clot blocks a brain blood vessel.

The research team found that relatively few patients received tPA, which works quickly to break up clots. In fact, only 543 of the 58,378 people admitted on weekdays got the drug, compared with 229 of the 20,279 admitted on weekends. The numbers show that the weekend stroke victims were 20% more likely to be given tPA than weekday arrivals.

During the week, neurologists are more likely to be involved with routine procedures, she notes. "Because there are fewer such elective procedures on weekends, patients have better access to expertise and better access to diagnostic technology such as CT [computed tomography] scanners," Kazley reasons. "They are also more likely to present at an earlier time, since they are less likely to have to battle traffic to get to the hospital."

The general rule is that tPA therapy is effective when given in the first three hours after an ischemic stroke occurs. The low rate of tPA therapy seen in the study "is similar to the national levels seen in other studies," Kazley says.

Despite the higher level of tPA treatment on weekends, no statistical significance in the death rates of the two groups was seen in the study. "You're looking at the 1% of patients who got the treatment, and [at those low numbers] it is very difficult to find a significant difference," Kazley says.

— Source: Brigham and Women's Hospital