THURSDAY, June 2 (HealthDay News) -- Use of a life-saving
clot-busting drug to treat ischemic strokes nearly doubled from
2005 through 2009, but the rates still remain too low, a new study
Acute ischemic stroke occurs when a blood clot cuts off blood
supply to the brain. Tissue plasminogen activator (tPA) is the only
thrombolytic (clot-dissolving) drug approved to treat this type of
stroke in the United States, and it can stave off death and lasting
disability, but only if it is administered within 3 to 4.5 hours of
"Overall, tPA treatment rates are improving, but the proportion of ischemic stroke patients receiving the therapy remains very small," said study author Dr. Opeolu Adeoye, an assistant professor of emergency medicine and neurosurgery at the University of Cincinnati in Ohio. "The delayed hospital arrival in the majority of stroke patients is probably the most important factor contributing to low treatment rates."
The findings are published June 2 in the journal
In the study, researchers used Medicare records and pharmacy
billing codes to see if tPA use had increased in response to
measures aimed at improving access to this treatment.
In 2005, 1.1 percent to 1.4 percent of acute ischemic stroke
patients received a thrombolytic drug, and 3.4 percent to 3.7
percent received one in 2009.
But after adjusting the numbers to account for billing or coding
errors, the researchers found that as many as 5.2 percent -- or
about 36,000 of the 700,000 Americans who had an ischemic stroke in
2009 -- received tPA. The study did not track individuals after
hospital discharge, so it does not provide any data on how they
fared following treatment. The presumption is that the tPA did
preserve function and prevent lasting stroke-related
"Increasing public awareness of stroke signs and symptoms, and earlier hospital arrival by stroke patients remain important goals for improving treatment rates further," Adeoye said. "The treatment can only be given in the first few hours after a stroke, but many patients delay seeking care, hoping the symptoms will go away," he noted.
"If someone is suspected of having a stroke, 911 should be called and the person immediately transported to the nearest stroke-ready emergency department," Adeoye explained.
Dr. Irene Katzan, director of the Primary Stroke Center at the
Cleveland Clinic in Ohio, said that the new study is great news and
confirms what she has seen in her practice. It is gratifying to see
that slowly things are moving along, she added.
In stroke care, the mantra is the sooner the better when it
comes to tPA use, but a lot has to happen in a very short period of
time. Also, some strokes may occur during sleep so the time of
onset of symptoms may be unknown, experts have noted.
Stroke symptoms may include sudden numbness or weakness of the
face, arm or leg (particularly on one side of the body), trouble
speaking or understanding speech, sudden vision problems, sudden
trouble walking, dizziness or balance issues, and a severe headache
with no other cause.
If someone has a stroke and 911 is called, the ambulance must
get them to a stroke center as soon as possible, Katzan said, and
there must be processes in place in the hospital to evaluate them
rapidly. She said tPA can't be used in bleeding strokes or in
individuals taking blood-thinning drugs, with high blood pressure
or high blood sugar (glucose) levels. Also, there are state
mandates that direct emergency medical services to take patients
with acute strokes to the closest stroke center.
"Then the patient would fly through the emergency room, get evaluated with a CAT scan and have blood work within minutes, and if they are a candidate, the intravenous tPA is started," Katzan said.
For this to occur, "everything has to be working correctly," she
When the drug is administered in the right patient, it can work
wonders. "Ideally, the person's stroke symptoms are minimal to none
three months after the stroke," Katzan said.
Dr. Roger Bonomo, director of stroke care at Lenox Hill Hospital
in New York City, said that although there is room for improvement,
"it's good news that tPA is being used more."
But obstacles remain. "We need to get people to come to the
hospital sooner rather than waiting a while to see if the stroke
symptoms get better on their own," he said.
Find out about stroke's warning signs at the
American Heart Association.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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