Navigation Links
Window for Stroke Treatment Opens Wider

Clot-busting drug found effective 4.5 hours after symptoms begin

THURSDAY, May 28 (HealthDay News) -- A new analysis showing that a potent clot-dissolving drug can safely be used to treat strokes four-and-a-half hours after symptoms begin has prompted a change in a current recommendation, which set a three-hour deadline for the medication's use.

The review of 1,622 cases of people treated with tissue plasminogen activator (tPA) in four separate studies finds that the benefit in keeping brain cells alive outweighs the risk of brain-damaging bleeding when the drug is given up to 4.5 hours after first symptoms, according to a report in the May 28 online issue of Stroke. The most convincing results came from the latest study, in which 821 people were treated later than is currently recommended.

"By pooling data from four prior clinical trials in which patients were treated with tPA between three and four-and-a-half hours, we were able to demonstrate that treatment with tPA is beneficial even if it is started between three and four-and-a-half hours of symptom onset," said study author Dr. Maarten Lansberg, an assistant professor of neurology and neurological sciences at Stanford University.

An advisory committee of the American Stroke Association/American Heart Association (ASA/AHA) promptly issued a recommendation that the window for tPA therapy be opened that much wider; that advisory appears in the same issue of Stroke.

"The advisory updates the current guidelines to recommend treatment in select patients in the three- to four-and-a-half hour window, but urges confirmation of the trial's results with further analyses," according to a statement issued by the ASA/AHA.

"In practical terms, wide adoption of the recommendation would mean that 2 percent to 3 percent more people who suffer strokes caused by blockage of a brain artery would receive tPA therapy," said Dr. Jeffrey L. Saver, a professor of neurology at the University of California, Los Angeles, and a member of the advisory committee.

That might not seem a great leap forward, but Saver noted that "right now, at well-performing hospitals, 5 to 10 percent of stroke patients are treated in under three hours."

"That disappointing number is due primarily to the widespread failure of people to know the symptoms of a stroke and take immediate action when they are seen," he said.

"This re-emphasizes that what we need to highlight for the public is the importance of getting aid as soon as symptoms begin," Saver said. "Therapy with tPA is most effective when given in the first hour. One hour is better than two, two is better than three, three is better than four. Should there be weakness on one side of the body, trouble speaking, trouble with vision, if any of those signs occur, call 911 at once."

The chief concern with tPA is that it might cause excess bleeding that damages the brain, Saver said. But data cited in the new study show that "for every 100 patients treated with tPA between three and four-and-a-half hours after symptoms, 16 will have a better outcome, and two or three will have a worse outcome," he said. "The treatment has risks, but we help six patients for every one we harm."

The benefit is seen in the 80 percent to 85 percent of strokes caused by an artery blockage. Treatment with tPA is not recommended for the 10 percent to 15 percent of strokes that are caused by a burst brain vessel.

The U.S. Food and Drug Administration set a three-hour limit on use of tPA in strokes when it was approved 13 years ago, Saver noted. "Now we have the first expansion of guidelines for giving a clot-dissolving drug, so it is an important advance in stroke care," he said.

But tPA should not be used beyond the three-hour limit in a number of cases, the advisory committee said -- people aged 80 and older, those having a severe stroke, those with a history of stroke and diabetes and those taking clot-preventing drugs such as Coumadin.

For anyone who has a stroke, "time lost is brain lost," Saver said. "Every minute, 2 million neurons die. What we want to see is door to needle time of 60 minutes."

More information

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

SOURCES: Maarten Lansberg, M.D., assistant professor, neurology and neurological sciences, Stanford University, Palo Alto, Calif.; Jeffrey L. Saver, professor, neurology, University of California, Los Angeles; May 28, 2009, Stroke

Copyright©2009 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Childrens Hospital Boston Deploys AutoVirt Solution to Increase Speed and Efficiency of Windows Data Replication
2. Microsoft Windows Embedded Announces Winner of SPARKs Will Fly Developer Contest
3. Newly Pregnant Smokers Have a 15-Week Window to Quit
4. New Survey Results Give a Window Into Teen Behavior and Risks
5. Stroke therapy window might be extended past nine hours for some
6. New Johns Hopkins imaging center to widen windows on the brain
7. Window World Cares Raises $160,000 for St. Jude Childrens Hospital, Commits to Ongoing Support
8. LSUHSC study finds high-dose HBO2 therapy extends survival window after cardiopulmonary arrest
9. CARDIA Studies Open Window on Heart, Lung Diseases
10. Samplify Systems Announces Availability of Samplify for Windows Release 2.6, and Samplify for Windows Embedded Edition, Transforming RF Data Recording Applications with X-COM Systems
11. MRI: A window to genetic properties of brain tumors
Post Your Comments:
Related Image:
Window for Stroke Treatment Opens Wider
(Date:11/29/2015)... ... November 29, 2015 , ... Key Housing, a top-rated corporate housing service ... 2015, featured apartment community: Epic. In showcasing this featured apartment community in San Jose, ... Area rental market to efficiently find housing suitable to their needs by showcasing quality ...
(Date:11/28/2015)... ... 28, 2015 , ... Beginning November 30th at 6:00 a.m. EST until 11:59 p.m. EST, ... possible savings of up to 20% off orders $80 or more to free gifts with ... few hours. , As a competitive e-commerce website for skin care and cosmetic needs, customers ...
(Date:11/27/2015)... CA (PRWEB) , ... November 27, 2015 , ... According ... carried out by the University of Toronto and the University of British Columbia suggested ... hospitalizations for head injuries. The article explains that part of the reason for the ...
(Date:11/27/2015)... ... November 27, 2015 , ... ... and convenient way to dispense prescription medications at home, so he invented the ... to monitor and dispense prescription medications. In doing so, it could help to ...
(Date:11/27/2015)... ... 27, 2015 , ... ProSidebar: Fashion is a set of 30 ... ProSidebar: Fasion, video editors can easily add an informative sidebar to any FCPX production. ... Utilize presets featuring self-animating drop zones, lines, bars, and text with the ease of ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... , Países Bajos, November 26, 2015 ... la terapia fotodinámica de Bremachlorin para el cáncer avanzado. ... la inmunoterapia con la terapia fotodinámica de Bremachlorin para ... Un nuevo enfoque combina la inmunoterapia con la terapia ... Clinical Cancer Research . --> ...
(Date:11/26/2015)... -- --> --> Juntendo ... optimal contrast weighting of MRI for patients with Multiple ... research agreement with SyntheticMR in order to use SyMRI in ... possible to generate multiple contrast images from a single scan ... thus making it possible to both fine tune images and ...
(Date:11/26/2015)... ) has ... Future Horizons and Growth Strategies in the ... Shares, Country Segment Forecasts, Competitive Intelligence, Emerging ... --> ) has announced the ... and Growth Strategies in the French Drugs ...
Breaking Medicine Technology: