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A stroke can be deadly — and if it doesn’t kill you, it can leave you with serious, often permanent, disabilities. So when a powerful clot-clearing drug called tPA (tissue plasminogen activator) was approved by the Food and Drug Administration in 1996, it was a game-changer in the treatment of ischemic strokes, which afflict about 795,000 people each year in the United States.
Stroke Patients Missing Out on tPA Medication
The powerful blood clot-clearing drug tPA can save lives of ischemic stroke patients, so why are some hospitals not prepared to use the treatment?
Keywords: ischemic stroke, blood clot, tPA, stroke centers, rural hospitals, stroke symptoms
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Fast-forward to today: Many tPA candidates are not getting the drug. In fact, of 61,698 eligible patients with acute ischemic stroke who arrived at a hospital within two hours of the onset of symptoms, 25 percent were not treated with tPA within three hours, according to a study in an October 2016 issue of Neurology. This is even though the American Stroke Association and American Heart Association strongly endorse giving tPA to eligible patients with acute ischemic stroke within three hours of the stroke’s onset.
So why isn’t this drug being given more consistently? Among the reasons: Many hospitals are not prepared to give tPA. "They do not have a stroke team that can ensure rapid evaluation of the patient, rapid acquisition of the CT scan and lab studies [such as blood tests for glucose, clotting time and platelet count] that are required before giving tPA, and then rapid decision making,” explains Howard Kirschner, M.D., a professor and vice chair of the department of neurology at the Vanderbilt University Medical Center in Nashville. “Stroke centers have a team ready to do this; many rural hospitals do not.”
Kirschner says some emergency physicians are reluctant to make a call about whether to give tPA to someone who has had an ischemic stroke, given that the drug carries a 6 percent risk of hemorrhage. ER doctors want a neurologist to make that call.
Also, tPA is used only for ischemic strokes, the most common type of which occurs when a blood clot cuts off supply to part of the brain. It is not used for hemorrhagic strokes, which occur when a weakened blood vessel in or around the brain ruptures, causing bleeding into the brain; with these types of strokes, tPA would worsen bleeding.