ORLANDO, Fla. (Ivanhoe Newswire) — About 87 percent of all strokes are ischemic, meaning they’re caused by a blood clot in the brain. For over 20 years, the standard of care has been a drug called TPA. But now, some doctors are questioning whether TPA is the best bet for patients.
When it comes to a stroke, time is brain. TPA, the only clot-busting drug approved to help lessen the damage has to be given within three hours.
But, research shows not everyone who arrives to the hospital on time receives TPA. In fact, up to 30 percent of stroke patients who are good candidates for the drug don’t get it. The reason? Some doctors are skeptical, saying studies showing it worked were flawed and the drug poses a risk of bleeding.
George J. Shaw, MD, University of Cincinnati College of Medicine, says, “Even if it’s given properly, about six percent of people will have bleeding in the brain just from the TPA. I’ve seen that a couple of times. It’s never good. It’s always bad.”
Still, the American Heart Association and the American Stroke Association strongly endorse the use of TPA in appropriate patients, calling it the “gold standard.” The landmark research that first brought attention to TPA happened more than 20 years ago. And since then, other studies have shown its benefits in reducing disability after stroke.
“About 1/3 of folks, if you look at them six months after their stroke and if they’ve gotten it tend to do better neurologically than those who haven’t gotten TPA,” continued Dr. Shaw.
The bottom line? TPA might be the only treatment for stroke, but it’s not one without risk.
Some doctors who disagree that TPA is the best treatment believe it’s better to let a stroke just run its course. They’re calling on more studies to prove the benefits outweigh the risks when it comes to TPA.
Contributors to this news report include: Julie Marks, Producer; David Harrison, Editor.
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STROKE CARE: THE TPA DEBATE?
BACKGROUND: On average, someone in the United States has a stroke every 40 seconds and it accounts for about one of every 17 deaths. A stroke is a sudden interruption in the blood supply of the brain. Most strokes are caused by an abrupt blockage of arteries leading to the brain (ischemic stroke). Other strokes are caused by bleeding into brain tissue when a blood vessel bursts (hemorrhagic stroke). Because stroke occurs rapidly and requires immediate treatment, a stroke is also called a brain attack. Stroke is the third leading cause of death in the United States and more than 140,000 people die each year. It is the leading cause of serious, long-term disability with approximately 795,000 people suffering a stroke. About 600,000 of these are first attacks, and 185,000 are recurrent attacks. Nearly three-quarters of all strokes occur in people over the age of 65, and the risk of having a stroke more than doubles each decade after the age of 55. Stroke death rates are higher for African-Americans than for whites, even at younger ages. High blood pressure is the most important risk factor for stroke.
MOST CURRENT TREATMENTS: There is only one FDA approved drug treatment for acute ischemic stroke. Tissue plasminogen activator (TPA) is given through an IV and works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. TPA should be given within three hours (and up to 4.5 hours in certain eligible patients) of the time symptoms first started. However, up to 30 percent of stroke patients who are good candidates for the drug don’t get it because some doctors are skeptical, saying studies showing it worked were flawed and the drug poses a risk of bleeding. Still, the American Heart Association and the American Stroke Association strongly endorse the use of TPA. If clot-busting drugs are ruled out, another option is where a surgeon inserts a small mechanical device into the blocked artery using a thin tube. Once inside, the tool traps the clot, and either breaks it up or the surgeon pulls it out of the brain, reopening the blocked blood vessel in the process. The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it. Some of the options for treatments include surgical clips or coils inserted in aneurisms, controlling high blood pressure, and surgery to remove the bleeding vessel and blood that has spilled into the brain. The chances of survival and recovery outcomes are even better if the stroke is identified and treated immediately.
NEW STROKE RESEARCH: Recent research is upending doctors’ long-held belief that they have just six hours to save threatened brain tissue from lack of blood flow when a major vessel to the brain is blocked. The new findings suggest they may have as long as 16 hours in many cases. And, a study published early this year with a different group of stroke victims put the outer limit at 24 hours for some. Both studies showed such dramatic results that they were cut short to speed up reporting of the information to physicians. “The big news is that we were all wrong in how we were thinking about how strokes evolve,” said Gregory W. Albers, a professor of neurology at Stanford University Medical Center and lead author. “While some brain tissue dies quickly after a stroke begins, in most patients, collateral blood vessels usually take over feeding a larger area of the brain that is also starved for blood and oxygen, giving doctors many more hours to save that tissue than they previously believed,” Albers said.
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