Clot-Busting Rx Has Long-Term Benefits

Stroke patients treated with alteplase soon after symptom onset reduce need for long-term care

(RxWiki News) When a person experiences stroke-like symptoms, receiving a clot-busting therapy right away can make a world of difference. Alteplase treatment may reduce long-term care and long-term costs.

Alteplase (brand name Activase) is a medication used by stroke victims to dissolve blood clots that have formed in blood vessels.

If patients can receive the therapy within four and a half hours of stroke symptoms appearing, they may be less likely to face long-term disabilities, according to new research.

"Ask your doctor about clot-dissolving medications."

Peter Sandercock, MD, professor of medical neurology and director of Edinburgh Neuroscience at the University of Edinburgh in Scotland, and his colleagues examined data on 3,035 patients from the third International Stroke Trial who had had ischemic stroke, which is caused by blockage in a blood vessel.

These patients were randomly assigned to either receive alteplase treatment within six hours of stroke onset or not receive the medication.

The researchers noted that those in the alteplase group had less disability at six months compared to those who did not receive the medication. The alteplase patients reported significantly fewer problems with long-term mobility, self-care, pain and discomfort and "needing help with everyday activities.”

When it came to overall survival rates at 18 months, there was no difference between the two groups.

The researchers stressed, however, that the breaking down of blood clots with the medication (thrombolysis) did lead to "statistically significant, clinically relevant improvements in functional outcome and health-related quality of life that are sustained for at least 18 months."

In a press release, Dr. Sandercock highlighted the potential cost-savings associated with the timely administration of alteplase. He said that annual costs for long-term care for a stroke patient who cannot function independently are about 13 times greater than for a patient who is considered independent.

Alteplase is a recombinant tissue plasminogen activator (rtPA) that is administered to a patient through a vein (intravenously). This tPA is an enzyme found naturally in the body that converts, or activates, plasminogen (a protein) into another enzyme to dissolve a blood clot and helps restore blood flow to the brain.

While the treatment was shown to be effective when given within four and a half hours of symptoms appearing, fewer than 15 percent to 40 percent of people arrived at the hospital within this treatment window, according to this study.

The scientists underscored that only 2 to 5 percent of patients who are suitable for thrombolysis with alteplase receive it.

This study was published in June in The Lancet.

Funding for this research was provided by UK Medical Research Council, Health Foundation UK, Stroke Association UK, Research Council of Norway, AFA Insurances Sweden, Swedish Heart Lung Fund, The Foundation of Marianne and Marcus Wallenberg, Polish Ministry of Science and Education, the Australian Heart Foundation, Australian National Health and Medical Research Council, Swiss National Research Foundation, Swiss Heart Foundation, Assessorato alla Sanita (Regione dell’Umbria, Italy), and Danube University.

The study authors reported receiving honoraria, expenses and fees from the pharmaceutical company Boehringer Ingelheim.

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Review Date: 
June 26, 2013