Large Stroke Study Confirms Value of Speed and tPA

A study of more than 2,700 stroke patients in six controlled clinical trials has confirmed the benefits of getting patients to the hospital quickly and giving them speedy thrombolytic treatment with tissue plasminogen activator (tPA). The results were reported in the March 6, 2004, issue of The Lancet.

Although doctors have known since a breakthrough study in 1995 that early thrombolytic therapy can improve a stroke patient's chance of full recovery, only about 2-5% of all U.S. eligible acute stroke patients are treated with tPA. In the study, those patients who were treated within 90 minutes of the onset of symptoms showed the most improvement. While the study suggests that tPA given up to four hours after symptoms appear may be beneficial, the authors note that the effect lessens as time goes on, and almost no benefit can be expected when tPA is given after six hours.

The pooled results of three other stroke trials also appear in the same issue of the Lancet. These results suggest that the beneficial effect of tPA may extend beyond three hours (from 181-270 minutes), and one trial failed to show any efficacy when tPA was given in the four-to-five-hour window.

"Once again we learn that time is brain,” said John R. Marler, M.D., one of the study authors and associate director for clinical trials at the U.S. National Institute of Neurological Disorders and Stroke (NINDS; Bethesda, MD, USA; www.ninds.nih.gov). "Although rapid stroke treatment presents a great challenge to physicians and may require substantial change in many healthcare systems, we now have stronger evidence that rapid early treatment offers the best chance of recovery for acute ischemic stroke patients.”




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