In the past, doctors couldn't use a powerful clot-busting drug for those patients who woke up with a stroke, because of the 4.5-hour rule - only use the drug if you know the symptoms appeared less than 4.5 hours ago.
Now, research gives early indicators that clot busters are OK for "wake-up" strokes:
In a non-randomized study, patients with a so-called "wake-up" stroke who had clinical signs and CT scans indicating only early ischemic changes had outcomes following thrombolysis similar to patients with a known symptom onset time, according to Dulka Manawadu, MD, of King's College London.
"I think the time is now right to prospectively randomize these patients with wake-up strokes into trials of thrombolysis," she reported at the American Stroke Association's International Stroke Conference here.
Steven Greenberg, MD, PhD, a neurologist at Harvard Medical School, said another approach, in addition to randomizing patients to tPA or no tPA, would be to use imaging to select patients who would most benefit from thrombolysis.More research could follow. This does, however, show the need for everyone to know stroke signs and know that help is needed quickly.
You can read MedPage's coverage of the conference by following this link.
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