Background and Purpose- Frequencies of treatment with r-tPA (recombinant tissue-type plasminogen activator) are increasing over the past 15 years. However, published data on the influence of various demographic and clinical factors on r-tPA treatment as well as estimates of future trajectories are limited. We evaluated time trends and future trajectories of r-tPA treatment in patients with acute stroke and the influence of various factors on r-tPA treatment by analyzing data of 103 970 patients enrolled in the Austrian Stroke Unit Registry from 2006 to 2018, of which 18 953 were treated with r-tPA. Methods- Time trends of r-tPA-treatment were investigated in predefined subgroups (minor/major stroke, age, anterior/posterior circulation stroke); limited exponential time series models were calculated to estimate future trends of r-tPA-treatment. Logistic regression models were calculated to estimate the influence of clinical variables on r-tPA-treatment. Results- Overall, r-tPA treatment frequencies increased from 9.9% in 2006 to 21.8% in 2018. We observed a particular increase in patients >80 years, patients presenting with a National Institutes of Health Stroke Scale Score of 2 to 3, patients with posterior circulation stroke, patients with wake-up stroke, and patients without atrial fibrillation. Forecast of overall r-tPA frequencies predicted a further but flattened increase up to 24% by 2025. Logistic regression of time-dependent associations of clinical variables with r-tPA-treatment revealed increasing odds of r-tPA-treatment in patients with a posterior circulation stroke and decreasing odds of r-tPA-treatment in patients with atrial fibrillation. Conclusions- We observed a positive development of r-tPA-treatment frequencies mirroring increasing confidence with intravenous thrombolysis in clinical practice; however, decreasing odds of r-tPA-treatment over time in patients with atrial fibrillation deserve particular attention.

中文翻译：

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急性缺血性卒中的r-tPA（重组组织型纤溶酶原激活物）治疗趋势和治疗影响因素。

背景和目的-在过去15年中，r-tPA（重组组织型纤溶酶原激活剂）的治疗频率正在增加。但是，有关各种人口统计学和临床​​因素对r-tPA治疗的影响以及对未来轨迹的估计的公开数据有限。我们通过分析2006年至2018年奥地利卒中病房登记处登记的103970名患者的数据，评估了急性卒中患者r-tPA治疗的时间趋势和未来轨迹以及各种因素对r-tPA治疗的影响。 953名患者接受了r-tPA治疗。方法-在预定的亚组中（小/大卒中，年龄，前/后循环卒中）研究了r-tPA治疗的时间趋势；计算了有限的指数时间序列模型，以估计r-tPA治疗的未来趋势。计算逻辑回归模型以估计临床变量对r-tPA治疗的影响。结果-总体而言，r-tPA的治疗频率从2006年的9.9％增加到2018年的21.8％。我们观察到> 80岁的患者，美国国立卫生研究院卒中量表评分为2到3的患者，后循环中风，有唤醒中风的患者和无房颤的患者。总体r-tPA频率的预测预测到2025年将进一步但趋于平缓的增长，最高可达24％。对临床变量与r-tPA治疗的时间依赖性关联进行逻辑回归表明，后路患者进行r-tPA治疗的几率增加心房颤动患者的循环性卒中和r-tPA治疗的可能性降低。结论-我们观察到r-tPA治疗频率的积极发展反映了临床实践中静脉溶栓治疗的信心增加；然而，随着时间的推移，房颤患者中r-tPA治疗的几率逐渐降低，值得特别注意。