Why do only 5% of stroke patients receive clot busting drugs? The National Stroke Association reports that stroke is the fourth leading cause of death in the United States, and a huge cause of disability as well. And 80% of strokes are preventable! What’s going on here?
All professions tend to resist change. But this resistance poses a problem for professions like medicine, since research can indicate that what doctors thought was best at one time is no longer effective, and doctors (like all of us) need to be flexible and humble enough to change when change is needed. One example of this resistance to change that I’ve seen firsthand is the tendency of doctors, especially ER doctors, to avoid giving clot-busting drugs to patients who come to the ER after the onset of stroke symptoms. The fear seems to be that these drugs may not be effective, or they may cause bleeding and the risk of bleeding exceeds the benefit of giving the drugs to break up clots causing a stroke. But these beliefs must change.
A quick review: strokes are the result of interrupted blood flow to the brain, like a heart attack is the result of a decreased blood flow to the heart. Stroke come in 2 forms – ischemic stroke and hemorrhagic stroke. Ischemic strokes are strokes that result from decreased blood flow caused by a blockage of some sort in one of the arteries supplying blood to the brain, whereas hemorrhagic strokes are caused by a rupture of a blood vessel supplying blood to the brain. By a huge margin, most strokes are ischemic strokes. The American Stroke Association says that 87% of all strokes are ischemic strokes.
Many studies have shown that giving a clot busting drug, like tPA, to ischemic stroke patients can be very effective in reducing the severity of the stroke and returning function. The sooner the drug is given, the better. As you’ve probably heard, “time is brain” in these circumstances. A recent study has shown that early treatment with tPA is extremely effective in reducing the severity of ischemic strokes and returning function to those patients.
Let me just give you their conclusion: “IV thrombolysis within 90 minutes is, compared to later thrombolysis, strongly and independently associated with excellent outcome in patients with moderate and mild stroke severity.” This is an important study, and gives great hope to the millions of stroke victims that early treatment can help them enormously. Here’s a link to a summary of this study.
An important point to remember is that this study deals with very early treatment – within 90 minutes of the stroke symptoms. That is not to say that later treatment is not effective in many patients. In fact, studies show benefits in many patients from treatment later than 90 minutes and perhaps up to 6 hours, according to this summary by emedicine of the benefits of thrombolytic therapy. The FDA recommends tPA be given within 3 hours of symptoms.
So, what should patients do to put themselves in the best position to benefit from drugs like tPA? This article on ischemic stroke says that one of the main things we need to do is be aware of stroke symptoms and act FAST.
- F – Face – Ask the person to smile. See if one side of the face droops
- A – Arms – Ask the person to raise both arms. See if one arm drifts downward
- S – Speech – Ask the person to repeat some simple phrase. See if they can’t repeat it or speak in gibberish
- T – Time – if any of these symptoms are present, call 911 immediately.