Clot Busting With tPA to Improve Outcomes

As you may know, stroke is the leading cause of long term disability in the United States and many other countries around the world. In fact, although stroke has dropped from the 3rd leading cause of death in the U.S. to the 5th in less than a decade, it still remains the 2nd world-wide. Although national organizations such as the American Stroke Association and the National Stroke Association have make great strides through initiatives to spread stroke awareness, we still have a long way to go to decrease the occurrence of stroke.

Some individuals are lucky enough to have very mild residual deficits from stroke thanks to life-saving medical advances such as tPA and thrombectomy. However, this is not the case for the majority. In fact, as of 2011, only 7% of patients presenting to hospitals nationwide with stroke symptoms were treated with tPA. This is largely due
to delays in seeking treatment. One main factor that makes ischemic stroke patients ineligible for tPA is hospital arrival past the window of opportunity. This window is generally within 3 hours although for some cases the window can be extended up to 4.5 hours. For this reason it is crucial that 911 is called for EMS transport to speed up the process once a potential stroke victim reaches the hospital.

Another difficulty in the consistent administration of tPA is some apprehension on the part of providers to administer the medication as there are risks involved. By being aware of these possible treatments as well as stroke symptoms to watch out for, you become your own advocate for discussing all possibilities in stroke care as well as requesting transfer to a primary stroke center if needed. One new release from Mass. General reported that only 75% of eligible individuals are getting tPA at 1600 hospitals studied. Although this seems like a large percentage, it ideally should be higher. If a patient is eligible for tPA, prompt and thorough education on the magnitude of success from this treatment as well as potential risks should be provided. Once informed consent is obtained the medication should be administered ASAP. Studies show the greatest benefit from tPA is seen when it is started within 90 minutes from the start of symptoms.

As a result of initiatives to improve “door to needle times” (the time between arrival to the hospital and start of tPA), hospitals have made great strides in improving the outcomes of stroke patients. However, the struggle of getting people through the door on time still remains. Appropriate use of tPA can sometimes eliminate long term effects of stroke. I’ve seen many patients after tPA with little to no deficit. When these patients are compared to the individuals who come in after having impairments for an extended period of time, it is evident how instrumental this treatment is in stroke care. Awareness efforts are unable to reach everyone and unfortunately the highest risk individuals are often the hardest to reach. Therefore, stroke advocates like ourselves rely on individuals like you to spread knowledge and be aware of what to look for. Stay informed and remember that time is brain!