Stroke-A Time Change for Care

Guidelines were made 6 yrs. ago and now there is a consensus resulting in a new document for medical personnel with ‘21 new recommendations as well as 50 revisions’ of existing recommendations*. To give you an idea of the complexity of aggressive stroke care– another 42 recommendations remain unchanged. In the past many patients having a stroke were excluded from receiving a clot-buster, now many of these contraindications have been dropped. These include those with a minor stroke, a rapidly improving stroke, recent major surgery, or a recent heart attack. It was believed but now proven incorrect that patients with minor or improving stroke should not get clot-busters

EMS also needs to be ready to bypass hospitals that may not offer certain procedures, such as advanced CT or MRI imaging (which is recommended before intravenous (IV) clot buster – tPA  can be given)

As is so common in drug therapy progress – FDA has approved tPA to be given within a 3-hour window of symptom onset while in Europe, the clot-busting drug is approved for up to 4.5 hours.

Genentech, maker of tPA, asked the FDA to approve the drug for the extended 4.5-hour time frame and provided the agency with additional data. But the FDA last spring declined the request.

“For each minute the brain goes without blood flow, there are 1.9 million nerve cells that are dying, that affect 14 billion nerve connections and 7.5 miles worth of never fibers”.

Health care providers believe patients are eligible to receive tPA, within 4.5 hours of symptom onset.

“What this tells us is we should treat patients as quickly as possible to reduce the likelihood they will have disability from a stroke.”

*Jauch EC, et al “Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association” Stroke 2013; 44; DOI: 10.1161/STR.0b013e318284056a.