Most Want Clot-Busting Rx When Stroke Strikes

Stroke emergency treatment with clot dissolving medication preferred by most adults surveyed

(RxWiki News) When a clot blocks blood flow to the brain, medication given immediately can limit damage. Stroke victims, however, may not be able to communicate their willingness to receive such therapy.

Thrombolytics (medications that can break down clots in blood vessels) can be very effective if given within three hours of first symptoms of an ischemic stroke (where a blood vessel is blocked).

To treat a life-threatening emergency, such as a stroke, a health care provider may not be able to get patient consent to administer such therapy.

A new investigation, however, found that most adults who are incapacitated by stroke would want to receive thrombolytics, even if they were unable to convey this wish.

"Get care immediately at the first sign of stroke."

Winston Chiong, MD, at the University of California, San Francisco, Memory and Aging Center, and his fellow researchers evaluated the preferences of 545 adults when it comes to treating stroke with clot-dissolving medication.

Dr. Chiong and colleagues compared these responses to patient preferences of 555 adults regarding the use of CPR (cardiopulmonary resuscitation) for treatment of sudden cardiac arrest (when the heart suddenly and unexpectedly stops beating).

Participants were all 50 years old or older.

The goal of this research was to gauge what the “presumption of consent” would be for patients who had a stroke.

In defining presumption of consent, the study authors wrote, "In life-threatening emergencies involving incapacitated patients without surrogates [agents who speak on behalf of patients], clinicians may intervene without obtaining informed consent, applying the presumption that reasonable people would consent to treatment in such circumstances.”

Those in the stroke opinion group read a scenario in which they were brought to a hospital after they had a severe acute ischemic stroke. This description included potential risks and benefits of treatment with thrombolysis. For some patients, thrombolysis can reestablish blood flow that can prevent harm to the brain and avoid disability. For others, however, the medication may cause damaging bleeding in the brain.

The CPR group read a depiction of a cardiac arrest experienced out of the hospital and potential outcomes after receiving CPR from paramedics.

Among those in the stroke scenario group, about 76 percent (419) said they would want clot-dissolving medication. About 76 percent (422) of the other group said they would want CPR for sudden cardiac arrest.

Results from this study showed that the proportion of adults who supported use of emergency thrombolysis was equal to the proportion who supported the emergency use of CPR. The authors noted that when patients are incapacitated with cardiac arrest, clinicians follow a generally accepted presumption of consent to use CPR to try and revive the patient.

“This finding provides empirical support for policy positions recently taken by professional societies that favor the use of thrombolysis for stroke in emergency circumstances under a presumption of consent,” the authors wrote.

Tissue plasminogen activator (brand names Activase and Alteplase) is the most commonly used thrombolytic medication to treat ischemic stroke.

Investigators said that the use of emergency thrombolysis has been controversial because this intervention improves functional outcomes but is not necessarily life-preserving.

The study was published in the April 23/30 issue of JAMA, a neurology theme issue. The research was supported by the National Institute on Aging, the National Center for Advancing Translational Sciences, and the American Brain Foundation Clinical Research Training Fellowship Program.

Review Date: 
April 21, 2014