Stroke Medication Effective When Given Properly
Feb. 29, 2000 (Washington) -- When administered by experienced doctors, tPA,
a medication mostly known for treatment of heart attacks, can improve the
recovery of patients who have had strokes, according to a study in the
Journal of the American Medical Association. But this study and another
published with it find that physicians often give the medication to patients
who shouldn't receive it and sometimes don't administer it quickly enough.
The results, researchers say, underscore the need for people who have
strokes to seek immediate medical attention.
For the many Americans who have strokes, treatment usually consists of a
rehabilitation period to help them regain speech, limb movement, and other
functions that might have been lost. Newer types of medication aimed at
reversing brain damage caused by stroke include tPA, or tissue-type plasmogen
The catch with tPA is that it must be administered within three hours of the
first symptom of a stroke to reduce the chance of further brain damage.
Government-run studies of stroke patients given tPA found that they had a
better long-term outcome than people who did not receive the medication, but
some also had more bleeding in the brain, which can be fatal. In addition to
the three-hour treatment window, patients who have been taking blood thinners,
or who have high blood pressure or a few other health problems, are not
supposed to receive tPA.
The larger of the two studies reported in the March 1 issue of JAMA
involved close to 400 stroke patients who received tPA. The study was funded by
Genentech, which manufactures tPA. Nearly all of the physicians involved were
experienced with tPA, having participated in earlier studies with the
medication. In this study, less than 4% of patients who received tPA had
symptoms of bleeding in the brain. Approximately one-third of the treated
patients had favorable outcomes.
However, these researchers also found that about a third of the time,
physicians violated the treatment rules in using tPA, often giving it after the
three-hour limit and when patients had taken blood thinners.
The other study, involving 29 hospitals, found that the treatment rules were
violated for about half the stroke patients studied. This study did not examine
whether the patients' health improved after being given tPA, but it found a
much higher incidence of bleeding in the brain of these patients when tPA was
given without following the guidelines. Both studies also showed that
physicians seemed to be giving tPA at the latest possible minute, with patients
getting the medication, on average, two hours and 44 minutes after symptoms
"I think [the findings] should be a reassuring message to consumers, but
should be a wake-up call to physicians that we need to treat them sooner in the
ER," Gregory Albers, MD, who led the larger study, tells WebMD. Albers is
with the Stanford Stroke Center at Stanford University in Palo Alto, Calif.