Beat the Clock and Stroke Disability

Strokes that are mild or moderate may cause no disability if patient receives medication quickly

(RxWiki News) At the first sign of stroke symptoms, patients should race to get clot-busting medication. Getting therapy quickly can make a huge difference when it comes to disability risk.

In an ischemic stroke, a fatty deposit in a blood vessel blocks blood flow to the brain. Brain cells are lost every second they are without oxygen from the blood. That’s why, no matter how severe the stroke is, the American Heart Association recommends getting to a hospital for treatment within three hours of symptoms appearing.

New research has found that individuals who had a mild-to-moderate stroke were less likely to have a permanent disability if they got therapy within 90 minutes of experiencing symptoms.

"When stroke symptoms strike, get treatment fast."

Daniel Strbian, MD, from the Department of Neurology at Helsinki University Central Hospital in Finland, along with fellow scientists analyzed data on 6,800 stroke patients at 10 stroke centers in Europe.

Patients were treated with alteplase, a clot-dissolving medication that is administered intravenously (through a vein). The medication is a tissue plasminogen activator (tPA) — an enzyme found naturally in the body that helps dissolve clots.

The researchers separated the subjects into one of three groups: those with a minor stroke, those with a mild/moderate stroke or those with a moderate/severe stroke.

Investigators determined the severity of each stroke using the National Institutes of Health Stroke Scale (NIHSS). The NIHSS is a 15-item neurological exam that gives healthcare professionals a systematic approach for evaluating the level of impairment caused by the stroke. It provides an assessment of brain function by gauging consciousness, vision, sensation, movement, speech and language.

Survivors with mild/moderate strokes who were given alteplase in the first 90 minutes of having symptoms had little or no disability three months later compared to those who were treated between 90 and 270 minutes, the authors wrote.

The minor stroke group had “excellent outcomes” as well from early therapy, but the likelihood of disability is already very low in these patients.

Dr. Strbian and his team noted, however, that the super-early treatment was not associated with “excellent outcomes” among those with severe stroke because they had severe artery blockage.

A five-year trial, conducted by the National Institute of Neurological Disorders and Stroke (NINDS), also showed the positive effects of tPA treatment. That study revealed that certain stroke patients who received the medication within three hours of the beginning of stroke symptoms were at least 33 percent more likely than patients given a placebo to recover from their stroke with little or no disability after three months.

Current guidelines say that tPA may be given up to 4.5 hours after symptoms appear, but the sooner it is given, the more effective it can be.

“Ultra-early treatment increases the likelihood of excellent outcome in patients with moderately severe symptoms, and in secondary analysis also in those with mild symptoms,” said Dr. Strbian in a press statement.

To spot the sudden signs of stroke and take appropriate action, the American Stroke Association 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.

This study was published in the American Heart Association journal Stroke. The authors reported receiving fees from Boehringer Ingelheim, which manufactures alteplase.

Review Date: 
August 23, 2013