Stroke Victims Need to Be Treated Within an Hour of Hospital Arrival

People undergoing an ischemic stroke should receive clot-dissolving therapy within 60 minutes of arriving at the hospital, according to the new guidelines of the American Stroke Association (Dallas, TX, USA).

The guidelines recommend that during an acute stroke, physicians must quickly evaluate and diagnose the patient as soon as possible to determine if they are eligible to receive the clot-dissolving drug recombinant tissue plasminogen activator (tPA), which must be given at most 4.5 hours within symptom onset. The goal of the guidelines is to minimize this "door to needle" time, which provides the patient with the best opportunity for benefit from the treatment.

The new guidelines also recommend integrating regional networks of comprehensive stroke centers (which offer continuous, highly specialized treatment for all types of stroke); primary stroke centers (which provide continuous specialized care, mainly for ischemic stroke); acute stroke-ready hospitals (which can evaluate and treat most strokes but lack highly specialized capabilities), and community hospitals. If feasible, patients should be rapidly transferred to the closest available certified primary care stroke center or comprehensive stroke center, which might involve air medical transport.

Other key recommendations in the new guidelines are that multidisciplinary quality improvement committees should be created within hospitals to review and monitor stroke care quality. The guidelines also suggest that while recently introduced stent retrievers could potentially remove large blood clots more completely and quickly than tPA, they should not be a substitute for intravenous tPA, and should thus only be used in clinical studies to determine if they improve patient outcomes. The new guidelines were published on January 31, 2013, in the journal Stroke.

“For patients brought to hospitals without specialized stroke expertise, telemedicine can provide real-time access to expertise. If such a hospital partners with a primary or comprehensive stroke center and uses telemedicine, early treatment decisions can be made for patients. If the patient had to be transferred before administering some therapies, it would be too late,” said Edward Jauch, MD, lead author of the guidelines and director of the Division of Emergency Medicine at the Medical University of South Carolina (Charleston, USA). “tPA can now be considered for a larger group of patients, including some those who present up to 4.5 hours from stroke onset.”

Related Links:
American Stroke Association