Speed Vital For Stroke Patients' Survival

Date: Jun-19-2013The sooner stroke patients receive thrombolytic treatment, the lower their risk of in-hospital mortality and intracranial hemorrhage, says a new study published in JAMA (Journal of the American Medical Association).

In addition, the prompter the treatment, the higher the rate of walking ability at discharge.

Intravenous (IV) tissue-type plasminogen activator (tPA) is a form of treatment proven to help stroke patients within 4.5 hours of onset of symptoms.

The authors wrote as background information "available evidence suggests a strong influence of time to therapy on the magnitude of treatment benefit."

A stroke occurs when brain cells suddenly die due to lack of oxygen caused by either a disruption in blood flow or a rupture of an artery to the brain. Following a stroke a patient may experience memory problems, inability to speak and paralysis.

Every two seconds a stroke occurs somewhere in the world, it is the major cause of acquired disabilities worldwide.

Using imaging techniques, researchers have found that irreversibly injured tissue in acute cerebral ischemia expands over time.

The researchers explained:

"However, modest sample sizes have limited characterization of the extent to which onset to treatment time (OTT) influences outcome; and the generalizability of findings to clinical practice is uncertain."

The study was led by Jeffrey L. Saver, M.D., of the David Geffen School of Medicine at UCLA, Los Angeles. The team had set out to determine whether there might me a link between time of treatment with intravenous thrombolysis and patient outcome among those who suffered from stroke.

The study included a total of 58,353 patients who were treated with tPA within 4.5 hours of suffering from acute ischemic stroke from 1,395 hospitals between 2003 and 2012.

The average age of the patients was 72 years.

The average OTT (onset to treatment time) was 2 hours and 24 minutes:

Only 9.3 percent had an OTT of less than 90 minutes
77.2 percent had an OTT of between 90 and 180 minutes
13.6 percent had an OTT of between 181 and 270 minutes

Greater stroke severity and arrival during regular hours were associated with shorter OTT.

In total, 19,491 lived and were able to walk at hospital discharge and 22,541 were discharged at home. The other 5,142 died in hospital, and 2,873 experienced an intracranial hemorrhage.

For every 15 minutes-faster interval of tPA therapy the researchers identified a lower risk of mortality or symptomatic intracranial hemorrhage and a higher chance of being able to walk at discharge.

Patients who were treated within 90 minutes of symptoms onset were 26 percent less likely to die, compared to those who received treatment within 181-270 minutes of symptoms.

The authors concluded:

"These findings support intensive efforts to accelerate patient presentation and to streamline regional and hospital systems of acute stroke care to compress OTT times."

Researchers at Stanford published a study in Stroke that showed that tpA treatment can benefit stroke patients up to 4.5 hours after the onset of symptoms.

Their study included a total of 1,622 patients who were admitted to hospital between three and 4.5 hours after their symptoms started, treatment with tPA improved the odds of a favorable outcome by 31 percent.

In conclusion, these findings highlight how important it is for a stroke patient to receive treatment as quickly as possible.
How to recognize a stroke
There are "Five Sudden, Severe Symptoms" - if any one of these five symptoms are recognized, call 911 (UK: 999) immediately, regardless of the age of the victim:

Sudden numbness or weakness of the face, arm, or leg on one side of the body.
Sudden confusion, difficulty talking or understanding.
Sudden trouble seeing on one side.
Sudden, severe difficulty walking, dizziness, loss of coordination or balance.
Sudden, severe headache for no known reason.

"No amount of readiness can make a difference unless someone recognizes the symptoms and calls 911," said Patrick D. Lyden, MD, chair of Neurology and director of the Stroke Program at Cedars-Sinai Medical Center.

George S. Groman, MD is a Cardiologist with Cardiovascular Specialists of Central Maryland discusses the risk factors for stroke, signs and symptoms of a stroke, and the effectiveness of tPA treatment.

Written by Joseph Nordqvist

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