More Stroke Victims Get Clot-Busting Therapy

But many others get to hospital too late to benefit, study finds

By Ed Edelson
HealthDay Reporter

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THURSDAY, Oct. 1 (HealthDay News) -- More stroke victims are getting a brain-saving drug -- tissue plasminogen activator (tPA) -- but many others aren't arriving at hospitals early enough to benefit from the treatment, a new study finds.

Duke University researchers reviewed records of 428 people brought to U.S. stroke centers in 2001, and 481 patients treated at those centers in 2004. In both years, only 37 percent arrived within two hours of the start of stroke symptoms.

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But 37.5 percent of those who arrived during that two-hour window received the clot-busting tPA therapy in 2004, compared to just 14 percent in 2001.

"It's a double-edged sword," said study author Dr. Larry B. Goldstein, director of the Duke Stroke Center, in Durham, N.C. His report is published in the Oct. 1 issue of Stroke.

"The organization of acute stroke care in hospitals has improved, so more patients are actually being treated, but the bad news part of it is that the proportion of patients who show up in time hasn't changed," he said.

The study "finds an important issue," said study lead author Judith H. Lichtman, an associate professor of epidemiology at Yale University. "We need to do a better job of having people identify stroke patients and get them to the hospital as quickly as possible."

The American Stroke Association/American Heart Association (ASA/AHA) currently recommends that tPA treatment start no later than three hours after onset of stroke symptoms. Because time is needed to assess patients' eligibility for the drug, the guidelines call for arrival two hours after symptom onset.

Recently, however, a study showed that the window may actually be wider. The findings in that case -- that the benefit of tPA treatment can outweigh the risk of brain-damaging bleeding if the therapy starts as late as four-and-a-half hours after symptom onset -- have led the ASA/AHA to say that later therapy can be done for "selected patients."

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