(HealthDay News) — For patients with acute ischemic stroke, social determinants of health (SDOH) are associated with the likelihood of receiving thrombolysis or mechanical thrombectomy, according to a study published online Oct. 16 in Neurology.
Chathurika S. Dhanasekara, M.D., Ph.D., from Texas Tech University Health Sciences Center in Lubbock, and colleagues conducted a retrospective cohort analysis using Texas Emergency Department Public Use Data (2016 to 2019), including adults diagnosed with acute ischemic stroke. The risk ratios (RRs) of administering thrombolysis and thrombectomy based on variables representing SDOH and a collective measure (the Social Vulnerability Index [SVI]) were computed.
Data were included for 139,852 patients with ischemic stroke; 12.3 and 4.3 percent received thrombolytic therapy and mechanical thrombectomy, respectively. The researchers found that the likelihood of thrombolysis was lower for those aged older than 65 versus 18 to 45 years (RR, 0.578); Black versus White individuals (RR, 0.801); Hispanic versus non-Hispanic individuals (RR, 0.936); Medicare/Medicaid/Veterans Affairs or uninsured versus private insurance holders (RR, 0.917 and 0.883, respectively); and those in a rural versus urban dwelling (RR, 0.782). Patients in the highest versus lowest quintile of the SVI were less likely to receive thrombolysis (RR, 0.926). The likelihood of receiving thrombectomy was lower for patients aged 65 years or older (RR, 0.787), Black or Hispanic patients (RRs, 0.745 and 0.919), those with Medicare/Medicaid/Veterans Affairs insurance (RR, 0.909), and those from a rural area (RR, 0.909). The SVI was also associated with a lower likelihood of undergoing mechanical thrombectomy (RR, 0.842).
“Our study provides evidence of socioeconomic disparities in access to thrombolysis or thrombectomy for acute ischemic stroke,” the authors write.
What is thrombolysis?
Thrombolysis, also known as thrombolytic therapy, is a medical procedure used to dissolve blood clots. It involves the administration of clot-busting medications, which break down the fibrin strands that hold clots together. This restoration of blood flow is crucial in preventing tissue damage and organ failure.
Thrombolysis is often employed in emergency situations, such as heart attacks and strokes. When a blood clot blocks an artery leading to the heart or brain, it can cause severe tissue damage if not treated promptly. By dissolving the clot, thrombolytic therapy can restore blood flow and limit the extent of injury.
The specific medications used in thrombolytic therapy vary depending on the underlying condition and patient factors. Common examples include tissue plasminogen activator (tPA), streptokinase, and urokinase. These drugs work by activating enzymes that break down fibrin, the protein that forms the framework of blood clots.
While thrombolytic therapy can be highly effective, it is not without risks. One of the primary concerns is bleeding, as the clot-busting medications can disrupt the body’s natural clotting mechanisms. For this reason, thrombolytic therapy is typically reserved for cases where the potential benefits outweigh the risks, such as when there is a high risk of severe tissue damage or death if the clot is not treated.
What is a mechanical thrombectomy?
Mechanical thrombectomy is a minimally invasive procedure used to remove blood clots from the brain. This technique has revolutionized the treatment of ischemic strokes, a condition caused by blockage of blood flow to the brain.
The procedure involves inserting a thin catheter through the femoral artery in the groin and guiding it to the site of the blood clot in the brain. Once the clot is located, a specialized device, often a stent retriever, is deployed to capture and remove the clot. This restoration of blood flow is crucial in preventing brain damage and improving patient outcomes.
Mechanical thrombectomy is typically performed within a few hours of stroke onset. The earlier the intervention, the greater the chances of a successful outcome. However, the procedure is not suitable for everyone. Patients with certain medical conditions, such as severe brain bleeding or a history of major blood vessel problems, may not be candidates.
The success rate of mechanical thrombectomy is high, with many patients experiencing significant improvement in their symptoms and functional abilities. However, the procedure is not without risks. Complications can include bleeding, stroke, and infection. Therefore, it is essential to carefully evaluate the potential benefits and risks before deciding on this treatment.
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