MONDAY, Feb. 13, 2006 (HealthDay News) -- Even though it can save lives threatened by stroke, only a very small percentage of patients are getting a powerful clot-busting drug, a new U.S. survey finds.
Of nearly 2,100 people treated for strokes caused by a blood clot at 15 hospitals in Michigan over a six-month period, just 2 percent received tissue plasminogen activator (tPA), according to a report published in Feb. 14 issue of Neurology.
The fault for the low use of tPA lies partially with hospitals, and partially with patients who wait too long to seek help for their symptoms. To work effectively, tPA must be given within three hours of the start of a stroke.
The main reason stroke patients didn't get tPA was a delay in getting to the hospital, said study author Mathew J. Reeves, an assistant professor of epidemiology at Michigan State University. Forty-one percent of those who didn't get the drug arrived after the three-hour, post-stroke limit, he said.
"There are lots of reasons why a patient doesn't arrive in time," Reeve said. "The first problem is recognition of the signs and symptoms of stroke. People don't recognize the warning signs of a stroke, and don't act on those warning signs."
Warning signs of stroke include dizziness, sudden weakness on one side of the body, and headache.
Indeed, medical records had no information as to exactly when the stroke started for 38 percent of patients, the report noted.
The time of arrival affected treatment in several ways. For patients in whom the time of onset was known, those who arrived in the second hour after symptoms were less than half as likely to get the drug than those who arrived in the first hour. Those who arrived between two and three hours after symptoms started were 33 times less likely to get tPA than those who arrived in the first hour.
Some of the blame for lack of tPA treatment also falls on hospitals, Reeves said.
"Ideally, the target is that when patients arrive at the hospital, tPA should be given within an hour," he said. "That requires diagnostic tests to make sure it is a stroke, and an ischemic stroke [one caused by a blood clot], and determining that there are no contraindications to giving tPA. Our data show that most hospitals take between one and two hours to do those things, so hospitals need to process patients more quickly."
So, while the primary need is "to educate the public to call 911, so that an emergency medical team arrives," it is also necessary that hospitals evaluate patients much more quickly than they are doing, Reeves said.
The value of calling 911 was illustrated by the recent finding that patients arriving by ambulance were seven times more likely to be given tPA than those arriving on their own. The paramedics who arrive in an ambulance when 911 is called can not only notify the hospital that a stroke patient is on the way but also perform preliminary tests that allow the person to be fast-tracked through the emergency department, Reeves said.
The value of recognizing and reporting stroke symptoms early is being confirmed in studies that use high-tech brain scans to show neurological damage after stroke, said Dr. David S. Liebeskind, associate neurological director of the University of California, Los Angeles, Stroke Center, who wrote an accompanying commentary.
"With advanced imaging modalities we can see early changes, a brain at risk but one not too late to save," said Liebeskind. "We realize that we can change the clinical course. Some patients will be devastated but others, if we reopen the blood vessel, can have a good outcome. There is a wide range of possibilities early on."
Treatments as simple as giving patients fluid, having them lie flat and constantly monitoring their blood pressure can improve the outcome, Liebeskind noted. Advanced magnetic resonance imaging scans at UCLA now can show details of a stroke as soon as 20 minutes after it occurs, he said.
More information
For more on the warning signs of stroke, head to the American Heart Association.
