Feb. 13, 2006 -- Many people delay seeking care for stroke, and it's high time that changed, doctors write in Neurology.
Few stroke patients arrive at a hospital quickly enough to get a clot-busting drug called tPA, write Y.Z. Deng, MD, and colleagues. The drug needs to be given within three hours after a stroke starts in order to be effective.
The researchers studied more than 2,500 stroke patients at 15 Michigan hospitals. Only 13% of those patients qualified for treatment with tPA, and even fewer -- 43 patients -- actually got the drug.
The biggest disqualifiers were arriving at a hospital more than three hours after a stroke started or not knowing when a stroke began, the researchers note.
Their advice: Learn stroke's warning signs, note when those symptoms start, and above all, get help immediately -- preferably by calling an ambulance -- for a suspected stroke.
No. 3 Cause of Death
Stroke is the No. 3 cause of death in the U.S. Nonfatal strokes can be disabling.
Every year, about 700,000 people in the U.S. have strokes. That averages out to one stroke about every 45 seconds, states the American Stroke Association.
Strokes happen when a blood vessel leading to the brain bursts (hemorrhagic stroke) or is blocked by a clot (ischemic stroke). Most strokes are ischemic strokes; tPA helps break up those clots when given promptly after a stroke's start.
Best Bet: Call an Ambulance
Stroke patients who arrived at a hospital by ambulance were more likely to get tPA, Deng and colleagues note.
Michigan State University's Matthew Reeves, PhD, who worked on the study, explains.
"People who arrive by ambulance are seen and evaluated more quickly in the emergency department," Reeves says in a news release.
Paramedics can gather information, do a quick neurological exam, and draw blood, he notes. "These steps allow the hospital to then 'fast-track' the patient through the emergency department, thus increasing the chance of meeting the three-hour deadline for tPA treatment," Reeves says.
Stroke's Warning Signs
The warning signs of a possible stroke include:
- Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
- Sudden confusion, trouble speaking, or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
Those signs may or may not indicate a stroke. With high stakes and a short time frame for treatment with tPA, getting emergency help right away is a must, note Deng and colleagues.
Here are the details from Deng's study:
- 330 out of 2,566 patients qualified for tPA treatment
- 43 patients actually got tPA
The top two reasons for not giving tPA were:
- Unknown stroke onset (35% of patients who didn't get tPA)
- Arrival at a hospital more than three hours after stroke onset (38% of patients who didn't get tPA)
About a fifth of patients who didn't get tPA had had bleeding hemorrhagic strokes, which tPA isn't used to treat. Others had had less severe transient ischemic attacks (TIAs).
Although tPA can help dissolve a clot that is causing an ischemic stroke, it can also result in significant bleeding complications. The researchers note that five out of the 43 patients given tPA had bleeding complications after treatment, with one death.
The decision to use tPA is based on many factors. Certain medical conditions or medical history would eliminate the option to use tPA even if you were to arrive to the ER in time. Clinical and laboratory findings may exclude the use of tPA. Also, even if offered, tPA use may be refused by a patient or family.
Some patients improved quickly enough not to need tPA, the researchers note. They say men were more likely than women to get tPA, and that more detailed medical records would have helped their study.