Stroke patients given a clot-busting agent within the first three hours of stroke symptoms are 30 percent to 50 percent more likely to have little or no disability after three months when compared to a control group, reported Emory and other researchers in a December issue of the New England Journal of Medicine (NEJM).
The administration of tissue plasminogen activator (t-PA) at the onset of stroke symptoms represents the first emergency treatment for strokes caused by blood clots.
Emory Stroke Center specialist Michael R. Frankel is principal investigator for the Atlanta component of the multisite, National Institutes of Health (NIH) trial and a co-author of the paper. He also is chief of neurology at Grady Hospital and assistant professor of neurology at the School of Medicine.
The four-year study evaluated 624 stroke patients nationally, including 39 stroke patients from the Atlanta area. All Atlanta patients were randomized to receive either placebo or t-PA upon arrival at Grady Hospital's Emergency Department or Emory Hospital's Treatment Room. All patients were in the throes of stroke when they entered the study.
Prior to the release of this study, no proven treatment existed for patients experiencing acute stroke, Frankel said.
The advantages of t-PA over other treatments for acute heart attack were widely publicized nearly a decade ago. Now t-PA is often standard treatment for patients brought to emergency departments during a heart attack. Results of the European Cooperative Acute Stroke Study, which looked at t-PA for stroke, were published in the Oct. 4, 1995, issue of the Journal of the American Medical Association. The European researchers concluded that while t-PA treatment was effective in a subgroup of stroke patients, therapy put others at risk for greater complications. Physician/researchers in the European study treated patients within six hours of the onset of stroke; NIH study investigators treated patients within three hours of symptom onset.
The major risk of t-PA is hemorrhage; bleeding in the brain can have disastrous consequences. Most acute-care hospitals in the United States currently have t-PA available in their pharmacies. The t-PA investigators suggest that physicians introduce the use of this new stroke therapy with great caution. They stress it would be a mistake for physicians to begin immediately using t-PA to treat acute stroke without careful evaluation and selection of appropriate patients as outlined in the NEJM article.
This treatment for acute stroke could potentially help many of the 400,000 Americans who every year face the devastation of stroke. If t-PA is to be appropriately used for more than a handful of stroke patients, however, substantial educational efforts by the health care community will be needed. These include intensive public education about stroke symptoms, education of physicians and nurses about the evaluation and treatment of stroke patients, and the rapid transport of stroke patients to the hospital by emergency medical services.
"Stroke is a medical emergency and should be treated with the same urgency as a heart attack," Frankel said.
-- Lorri Preston