Ultra-Early Treatment of Strokes Reduces Risk of Disability

In the case of mild or moderate strokes, treatment within 90 minutes of experiencing symptoms greatly reduces the risk of suffering disability, according to a new study.

Researchers at Helsinki University Central Hospital (Finland), the University of Heidelberg (Germany), and other institutions prospectively collected and merged data regarding 6,856 consecutive ischemic stroke patients who received intravenous (IV) thrombolysis in 10 European stroke centers. The researchers used logistic regression to test the association between treatment delays, as well as 3-month outcome (based on the modified Rankin scale) and mortality. The association was tested separately in tertiles of baseline National Institutes of Health Stroke Scale (NIHSS).

The results showed that shorter onset-to-treatment time, as a continuous variable, was significantly associated with excellent outcome. After adjusting for age, sex, admission glucose level, and year of treatment, onset-to-treatment time shorter than 90 minutes was associated with excellent outcome in patients with NIHSS 7–12, but not in patients with baseline NIHSS higher than 12 and lower than 6. Every fifth patient had onset-to-treatment time lower than 90 minutes, and these patients had lower frequency of intracranial hemorrhage. Ultra-early treatment was not associated with mortality. The study was published in the August 22, 2013, issue of Stroke.

“Ultra-early treatment increases the likelihood of excellent outcome in patients with moderately severe symptoms, and in secondary analysis also in those with mild symptoms,” said lead author Daniel Strbian, MD, PhD, and colleagues of the department of neurology. “All measures must be taken to reduce onset-to-treatment time as much as possible.”

The patients in the study were treated with Alteplase, a recombinant tissue plasminogen activator (tPA) manufacture by Genentech (San Francisco, CA, USA). It is a serine protease found on endothelial cells that line the blood vessels. As an enzyme, it catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown. Use of tPA is contraindicated in hemorrhagic stroke and head trauma.

Related Links:
Helsinki University Central Hospital
University of Heidelberg
Genentech