Clot-Busting Drugs Are Effective, but They Must Be Given Soon After a Stroke
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Reviewed By Laura J. Martin, MD
June 3, 2010 -- About one in four patients makes it to the hospital during a stroke within an hour of the onset of symptoms -- the optimal time for treatment with clot-busting drugs, a study shows.
But just one in five of these patients who were candidates for the treatment actually got it within an hour of hospital arrival.
Most strokes are caused by blood clots that block the flow of blood to the brain. Clot-busting tPa drugs help dissolve these blood clots, but prompt treatment is critical.
The drugs can be used up to 4 and 1/2 hours after stroke symptoms first occur, and national guidelines call for the treatment of eligible patients within 60 minutes of arrival at the hospital.
When researchers examined hospital data on almost 107,000 stroke patients, they found that this goal was met for just 18% of treatment-eligible patients who got to the hospital within 60 minutes of first recognizing symptoms.
The study was published online today in the journal Stroke.
Neurologist and researcher Lee H. Schwamm, MD, of Massachusetts General Hospital, says patients who arrive at the hospital earliest stand to benefit most from treatment, but medical personnel may not act as quickly when they know the treatment window is longer.
"It is human nature to slow down when you have more time," he tells WebMD. "Someone who is evaluating a patient may take an extra 15 minutes to review a scan or consult with a family member when they think they have the time. But patients need to be treated as soon as possible."
Don't Delay, Call 911
Patients who arrived at the hospital within 60 minutes of symptom onset were 2 and 1/2 times more likely to receive treatment with tPA than patients who arrived between 61 minutes and three hours after symptoms first occurred.
The study included patients treated at 905 hospitals participating in a stroke treatment program.
In addition to evaluating how quickly patients reached the hospital, the study also examined factors associated with early hospital arrival.
As has been reported in other studies, patients who were taken to the hospital in an ambulance were more likely to get there quicker and be treated more promptly than patients who arrived at hospital ERs on their own.
American Heart Association (AHA) president elect Ralph L. Sacco, MD, says the first thing someone should do when a stroke is suspected is call 911.
"Even if someone thinks they can get a patient to the hospital faster, it is important to call 911," he says. "Ambulance medical personnel will be able to triage the patient and alert the hospital medical team before arrival."
Know the Symptoms of Stroke
Stroke is the third leading killer and the leading cause of long-term disability in the U.S., according to the AHA.
Study researcher Jeffrey L. Saver, MD, a stroke specialist at the University of California, Los Angeles, says people with risk factors for stroke and their loved ones should memorize the warning signs of stroke and call 911 immediately if they occur.
The symptoms include:
- Sudden weakness or tingling on one side of the body
- Sudden loss of vision
- Sudden speech problems
- Sudden severe dizziness
- Sudden severe headache
Any one symptom or combination of symptoms can mean someone is having a stroke.
In an effort to educate the public about stroke symptoms, the National Stroke Association launched the Act F.A.S.T. campaign early last year.
Act F.A.S.T. stands for:
- Face. Ask the patient to smile. Does one side of the face droop?
- Arms: Ask the patient to raise both arms. Does one arm drift downward?
- Speech. Ask the patient to repeat a simple sentence. Does he or she have trouble or are the words slurred?
- Time. Time is critical. Call 911 immediately if one or more of these symptoms are identified.
SOURCES: Saver, J.L. Stroke: Journal of the American Heart Association, July 2010; online edition.
Jeffrey L. Saver, MD, University of California, Los Angeles Stroke Center.
Lee H. Schwamm, MD, department of neurology, Massachusetts General Hospital, Boston.
Ralph L. Sacco, MD, president-elect, American Heart Association; professor and chairman, department of neurology, Miller School of Medicine, University of Miami.
News release, American Heart Association.
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