Tuesday, February 25, 2014

Clot-busting tPA: Good news and bad news

I was fortunate enough to benefit from a drug called tissue plasminogen activator, or tPA, on the day of my stroke. Click here to read more about that experience.

The drug has made news in recent days. First, more patients are getting help faster, according to an article about how the "Target Stroke" initiative cuts time to tPA:
Photo from U.S. Centers for Disease Control and Prevention
The percentage of patients with a door-to-needle time of 60 minutes or less was 29.6% just before the "Target: Stroke" initiative was implemented at the beginning of 2010 and 53.3% in the third quarter of 2013 ...,  a clinically relevant improvement, according to Gregg Fonarow, MD, of the University of California Los Angeles.
At the same time, clinical outcomes improved and complications from the use of tissue plasminogen activator (tPA) fell, he reported at the International Stroke Conference here.
Speaking of tPA, more recent research confirms that the drug is clearly associated with less long-term disability. Stroke is the leading cause of permanent disability in the United States. You can read through this link how thrombolysis limits stroke regardless of age, severity:
A new meta-analysis confirms that regardless of patient age or stroke severity, thrombolytic treatment of ischemic stroke is associated with less long-term disability.
Although earlier treatment was associated with better outcomes, patients in every subgroup of age and stroke severity receiving tissue plasminogen activator (tPA) within 4.5 hours of symptom onset benefited from treatment, with more patients left with little or no disability, including patients over 80 years of age.
Now, the not-so-good news. Still, another study reveals, few stroke patients get the clot-busting drug:
"We are not making a great deal of progress," says the study's lead author, Opeolu Adeoye, an associate professor of emergency medicine and neurosurgery at the University of Cincinnati.
The medication, called tPA, or tissue plasminogen activator, can dissolve the blood clots that cause most strokes, often sparing patients from devastating brain damage. The drug increases the chance that a stroke patient will be able to regain normal functions and return home by about 30%, Adeoye says.
But tPA, approved for strokes in 1996, only works if given within 4.5 hours of a stroke. Hospitals have worked to streamline their systems to get patients care as quickly as possible, says Victor Urrutia, medical director of the comprehensive stroke center at Johns Hopkins Hospital in Baltimore, who wasn't involved in the new study. Yet, he says, "It's really striking that this number hasn't increased much over the years."
So there's more work to accomplish so that this drug - even with its imperfection - can benefit so many and prevent or curtail serious disabilities.

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