With Stroke, 15 Minutes Can Be a Lifesaver

Stroke victims improve odds of survival the faster they can receive clot busting medication

(RxWiki News) For stroke victims, getting therapy to dissolve a blood clot may be a lifesaver and prevent devastating disability. The quicker these individuals act, the better the outcome is likely to be.

Tissue plasminogen activator (tPA) is a medication that has been shown to bring back blood flow to the brain by breaking down the clots that are blocking the flow. To work well, tPA has to be given soon after stroke symptoms appear.

In a large new study, scientists have found that earlier therapy following stroke may reduce in-hospital deaths and bleeding inside the skull, while also increasing the likelihood of walking independently at discharge from the hospital.

"Call 9-1-1 immediately at any sign of stroke."

Jeffrey Saver, MD, a neurology professor at the David Geffen School of Medicine at UCLA, Los Angeles, and colleagues investigated the link between the time to treatment with intravenous tPA and the outcomes of patients with acute ischemic stroke.

The study included data from 58,353 patients with acute ischemic stroke treated with tPA (brand name Activase) within 4.5 hours of symptoms appearing. tPA treatment can provide benefit for select patients with acute ischemic stroke up to 4.5 hours after experiencing symptoms.

tPA is an enzyme found naturally in the body that converts, or activates, plasminogen (a protein) into another enzyme to dissolve a blood clot.

Patients in this study came from 1,395 hospitals participating in the Get With The Guidelines-Stroke Program. The midpoint age of the patients was 72.

The researchers observed that for every 15 minutes faster tPA therapy was given, death and bleeding inside the skull (intracranial hemorrhage) were less likely to occur. Also, independent walking at discharge and discharge to home were also more likely to occur.

For patients treated in the first 90 minutes compared with 181 to 270 minutes after onset of symptoms, death was 26 percent less likely to occur. Intracranial hemorrhage was 28 percent less likely to occur. Independent walking at discharge was 51 percent more likely to occur, and discharge to home was 33 percent more likely to occur.

The time of onset of stroke symptoms to treatment (OTT) was 144 minutes on average in this investigation. Only about 9 percent had an OTT time of 0 to 90 minutes, while 77 percent had an OTT time of 91 to 180 minutes. Almost 14 percent had an OTT time of 181 to 270 minutes.

The study authors noted several factors that were associated with shorter OTT times: greater stroke severity, arrival by ambulance and arrival to the hospital during regular hours.

"These findings support intensive efforts to accelerate patient presentation [get to the hospital faster] and to streamline regional and hospital systems of acute stroke care to compress OTT times," the authors concluded.

To recognize the signs of stroke and take appropriate action, the National Stroke Association recommends an easy-to-remember system called F.A.S.T.:

  • Face drooping: Does one side of the face droop or is it numb?
  • Arm weakness: Is one arm weak or numb?
  • Speech difficulty: Is speech slurred, are you unable to speak, or are you hard to understand?
  • Time to call 9-1-1: If you have any of these symptoms, even if the symptoms go away, call 9-1-1 and get to the hospital immediately.

This study was published in June in the Journal of the American Medical Association. No conflicts of interest were noted.

Reviewed by: 
Review Date: 
June 24, 2013