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More Stroke Victims Get Clot-Busting Therapy
Date:10/1/2009

But many others get to hospital too late to benefit, study finds

THURSDAY, Oct. 1 (HealthDay News) -- More stroke victims are getting a brain-saving drug -- tissue plasminogen activator (tPA) -- but many others aren't arriving at hospitals early enough to benefit from the treatment, a new study finds.

Duke University researchers reviewed records of 428 people brought to U.S. stroke centers in 2001, and 481 patients treated at those centers in 2004. In both years, only 37 percent arrived within two hours of the start of stroke symptoms.

But 37.5 percent of those who arrived during that two-hour window received the clot-busting tPA therapy in 2004, compared to just 14 percent in 2001.

"It's a double-edged sword," said study author Dr. Larry B. Goldstein, director of the Duke Stroke Center, in Durham, N.C. His report is published in the Oct. 1 issue of Stroke.

"The organization of acute stroke care in hospitals has improved, so more patients are actually being treated, but the bad news part of it is that the proportion of patients who show up in time hasn't changed," he said.

The study "finds an important issue," said study lead author Judith H. Lichtman, an associate professor of epidemiology at Yale University. "We need to do a better job of having people identify stroke patients and get them to the hospital as quickly as possible."

The American Stroke Association/American Heart Association (ASA/AHA) currently recommends that tPA treatment start no later than three hours after onset of stroke symptoms. Because time is needed to assess patients' eligibility for the drug, the guidelines call for arrival two hours after symptom onset.

Recently, however, a study showed that the window may actually be wider. The findings in that case -- that the benefit of tPA treatment can outweigh the risk of brain-damaging bleeding if the therapy starts as late as four-and-a-half hours after symptom onset -- have led the ASA/AHA to say that later therapy can be done for "selected patients."

The Duke study shows that half of those brought to stroke centers arrive within three hours of symptom onset, said Dr. Brian Silver, an assistant professor of neurology at Wayne State University who practices at Henry Ford Hospital, both in Detroit. "If you expanded the tPA window, you could go to 50 percent being treated," said Silver, a spokesman for the ASA/AHA.

But it is not clear whether other medical organizations will support an expanded window for tPA therapy, and the most important issue is getting people to hospitals for treatment quicker, since brain damage increases steadily with time, Silver said.

"We want to get patients treated as early as possible," he said.

"We need to educate the public, as well as family members of people at risk of stroke, so that they will be aware of the symptoms and respond quickly," Goldstein said.

The warning signs of stroke include sudden weakness of the face, arm or leg, especially on one side of the body; sudden confusion and difficulty in speaking; sudden trouble in seeing; sudden dizziness or loss of balance and sudden severe headache.

It's not possible to tell if arrival times have changed since 2004, the last year for which information on stroke treatment is available, Lichtman said. "What this study shows us is how important it is to monitor trends over time, to see how well we are doing on the patient front and on the system front," she said.

With a better sense of those trends, "we can focus on improving care and outcome," she added.

More information

Stroke symptoms and what to do about them are described by the American Heart Association.



SOURCES: Larry B. Goldstein, M.D., professor, neurology, Duke University, and director, Duke Stroke Center, Durham, N.C.; Judith H. Lichtman, Ph.D, associate professor, epidemiology, Yale University, New Haven, CT; Brian Silver, M.D., assistant professor, neurology, Wayne State University, Detroit, and neurologist, Henry Ford Hospital, Detroit; Oct 1, 2009 Stroke


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