The Clock Is Ticking When Stroke Strikes

Stroke victims need clot busting therapy within 60 minutes of hospital arrival

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) When a person has a stroke, a clot in an artery blocks blood flow to the brain. For the best recovery results, patients need to receive treatment fast.

An interruption of blood flow to the brain—called an acute ischemic stroke—needs to be treated with clot-busting medications within an hour of arriving at the hospital for best results, according to new guidelines issued by the American Stroke Association (ASA).

A clot starves the brain of oxygen, killing brain cells. The longer treatment is delayed, the more likely a patient will experience problems such as paralysis and speech or vision impairment.

"Call 911 immediately if having signs of stroke."

Edward Jauch, MD, director of the Division of Emergency Medicine at the Medical University of South Carolina in Charleston, served as lead author on these guidelines for ischemic stroke, which accounts for nine out of 10 strokes.

For optimal stroke care, patients are advised to call 911 immediately after recognizing any of the warning signs of stroke and to get to a stroke center as fast as possible. Signs of stroke include a droopy face, weak arms and difficulty speaking.

According to the American Heart Association (AHA), acute ischemic stroke is the leading cause of disability and the fourth most common cause of death in the United States.

During an acute stroke, doctors must quickly evaluate and diagnose the patient as soon as possible to determine if he or she is eligible to receive the clot-dissolving medication called recombinant tissue plasminogen activator (tPA).

The medication must be taken within four and a half hours after stroke symptoms begin. Fast action gives patients the best opportunity to benefit from the treatment. If too much time has passed since symptoms began, the medicine may not help the patient.

“tPA can now be considered for a larger group of patients, including some who present up to 4.5 hours from stroke onset,” said Dr. Jauch.

The guidelines also note that recently introduced “stent retrievers” could potentially remove large blood clots more completely and quickly than tPA. Stent retrievers are devices that shouldn’t be a substitute for intravenous tPA and should only be used in clinical studies to determine if they improve patient outcomes, according to the ASA.

The guidelines also recommend an integration of comprehensive stroke healthcare services.

To remember the sudden signs of stroke and take appropriate action, the ASA endorses 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.

The new American Stroke Association guidelines were published at the end of January in the American Heart Association's journal Stroke.

Reviewed by: 
Review Date: 
February 20, 2013
Last Updated:
August 16, 2013