Reasons why few patients with acute stroke receive tissue plasminogen activator

Arch Neurol. 2006 May;63(5):661-4. doi: 10.1001/archneur.63.5.661.


Despite the US Food and Drug Administration's approval in 1996, tissue plasminogen activator (tPA) therapy for acute ischemic stroke remains substantially underused. We reviewed 3 potential reasons for low rates of tPA use: poor patient education, physicians' perceived risk of legal liability from negative patient outcomes, and insufficient reimbursement. The recent addition of diagnosis-related grouping code 559 will provide higher payment for stroke patients treated with tPA, creating a natural experiment to examine our third reason.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Drug Utilization / statistics & numerical data
  • Humans
  • Patient Selection
  • Risk
  • Stroke / drug therapy*
  • Stroke / economics
  • Tissue Plasminogen Activator / economics
  • Tissue Plasminogen Activator / therapeutic use*


  • Tissue Plasminogen Activator