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Stroke Medication Effective When Given Properly

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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 activator.

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 began.

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