He also found that experience mattered. Hospitals that treated a large number of stroke patients were more likely to administer the drug within that 60-minute window.
Those who got the drug in under 60 minutes were also less likely to die during their hospital stay than those who didn't. While only 8.6 percent of those who got the tPA within the ideal window died while in the hospital, 10.4 percent of those who got the drug less promptly did, the researchers said.
The results confirm other studies suggesting that busier stroke centers do better with stroke care, said Dr. Patrick Lyden, chief of neurology at Cedars-Sinai Medical Center in Los Angeles, who reviewed the findings but was not involved in the research.
The same has held true, he said, for heart surgery and hip replacement surgery. "Busier places do better," he said. "The next step is to get patients to the busiest stroke centers faster."
First approved by the U.S. Food and Drug Administration in 1996, tPA is used to treat ischemic stroke within the first three hours after the onset of symptoms, with certain conditions in a stroke patient ruling out its use. While doctors must decide who is and isn't a candidate for tPA, loved ones can do much to speed up treatment if a stroke occurs in a family member or friend, Fonarow said.
"Call 911 without delay," Fonarow said. Don't try to drive a patient to the hospital, he tells loved ones; rather, order an ambulance. Time lost is brain lost, Fonarow and other neurologists caution.
The Get with the Guidelines-Stroke program is supported in part by the American Heart Association Pharmaceutical Roundtable and the Bristol-Myers Squib/Sanofi Pharmaceutical Partnership. Fonarow reports receiving research support from the National Institutes of Health and serving as a consultant to Pfizer, Merck and other pharmaceutical companies.
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