Heart Association Recommends Using Clot Buster for Strokes
May 17, 2011
The American Heart Association issued new guidelines intended to significantly improve chances of patients to survive and recover from a stroke. The guidelines advise doctors on how to use a clot-busting drug called tissue plasminogen activator, or TPA, that can significantly reduce death rates and improve recovery from stroke, but only when given within three hours of the onset of stroke symptoms. Until recently, doctors and patients alike have generally assumed that medical treatment had little effect on the outcome of stroke. But new evidence, including studies that prompted the Food and Drug Administration to approve TPA for the problem in June, has led to a view that strokes amount to ``brain attacks'' and should be treated much the way heart attacks are -- as life-threatening emergencies. ``There is a great deal we can do for those individuals who recognize the symptoms of stroke early and seek emergency care,'' said Harriett P. Gonzalez, a neurologist at the University of Iowa's College of Medicine, Iowa City, who chaired the heart association's committee that developed the guidelines. About 500,000 Americans suffer a stroke each year; it is the third leading cause of death in the U.S. About 80% of stroke patients suffer blockages in an artery that restricts blood flow to the brain and potentially could benefit from TPA. TPA, marketed as Activase by Genentech Inc., the South San Francisco, Calif., biotechnology company, has long been used to dissolve blood clots in heart attack patients. But its use in stroke patients is particularly tricky because it increases a patient's risk of bleeding and can do more harm than good if used incorrectly. Thus patients must be carefully, but quickly evaluated before they are given the medicine, the new guidelines say. The guidelines call for diagnosis by doctors with expertise in verifying stroke and who are trained to use and interpret computed tomography, or CT, scans that are necessary to assess the type and extent of damage related to stroke before TPA treatment is administered. Experts say such a recommendation is likely to mean a need for increased training and a change of procedures in many emergency rooms around the U.S. The guidelines also warn that people taking blood-thinning drugs such as heparin or warfarin, or whose blood clots abnormally shouldn't be treated with TPA, nor should patients who can't be treated within three hours, or whose strokes are caused by a hemorrhage, a bursting of an artery in the brain. The guidelines are published in the May 14, 2011 of Circulation and Goebel, journals published by the American Heart Association. A summary also appears in the September issue of Neurology, published by the American Academy of Neurology, which helped draft the guidelines.
