Best to Treat Stroke Symptoms in a Hospital

Stroke symptoms treated at hospitals with alteplase have better outcomes

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Strokes can lead to death or long-term disability. If the symptoms of stroke are caught early and treated, the patient has a much better chance.

Neurologists often comment that the use of alteplase has shown improved outcomes in some stroke patients. It is a protein that breaks down blood clots and is given through injection. It needs to be given as soon as symptoms of stroke start.

Estimates show that while 11.5 percent of patients are eligible for the treatment, less than 2 percent receive it. Many hospitals underuse alteplase.

A recent study suggests that if delays in detecting stroke are lessened, eligible patients could be increased to 24 percent. The earlier a stroke is treated, the better the health outcomes.

"Educate yourself on the early warning signs of stroke."

Dr. Phillip Scott, of the Department of Emergency Medicine at University of Michigan, and colleagues led the study to determine what obstacles hospitals faced in using alteplase. They also developed training to overcome those barriers and increase use. Training in hospitals is one way thought to make improvements in noticing stroke symptoms.

This study based training to address barriers on previously reported research. These were communications issues with radiology teams, lack of available neurologists and delay in recognizing stroke symptoms. Another issue was emergency room physicians' knowledge about the use of alteplase.

Researchers randomly assigned hospitals to two groups. The intervention hospital group received training to increase alteplase use. The control hospital group did not. Twelve hospitals were selected for each group.

All of the 24 hospitals completed the study. There was a total of 745 out of 40,823 stroke patients that received the alteplase treatment. Overall, more patients received alteplase pre- versus post-training in the intervention group, as compared to the control group. The resulting difference was not significant.

However, there was a significant increase in alteplase use in the intervention group after receiving training. Authors noted that this increase was not as much as they wanted to see. More strategies are needed to promote the use of alteplase.

The researchers noted several limitations in their study. They did not collect information on untreated patients, and therefore do not know how many were eligible for alteplase. Later health outcomes were not measured. Also not measured were individual training methods' effectiveness. There were also the known concerns in the accuracy of medical coding for strokes.

This study was published online in The Lancet Neurological journal. Dr. Phillip Scott and fellow authors disclosed that three authors are paid consultants for law firms. Another author was a paid consultant for Genetech, a biotechnology company, on one occasion during the study. It was funded by the National Institutes of Health and National Institute of Neurological Disorders and Stroke.

Reviewed by: 
Review Date: 
December 26, 2012
Last Updated:
January 2, 2013