Who will benefit from stroke drug? New score can help decide

A new scoring method can help doctors quickly decide which stroke patients will respond well to the clot-busting drug alteplase, according to a study published in the February 7, 2012, print issue of Neurology, the medical journal of the American Academy of Neurology.

The DRAGON score was 86 percent accurate in predicting the outcome three months after people had the stroke and received the drug within four-and-a-half hours after their first stroke symptoms.

"The DRAGON score is simple and fast to perform, it has no cost, and it consists solely of factors that are known when the patient is admitted to the hospital or soon after," said study author Daniel Strbian, MD, PhD, of Helsinki University Central Hospital in Finland. "We found that we could determine the score in less than a minute. This can help the doctor, the patient, and the family to evaluate the situation, make choices and give the most relevant treatment with the greatest speed."

Strbian said the score can help with the decision to try additional therapies when the likelihood is high that alteplase alone will not provide a good outcome.

The study involved 1,319 people with with an average age of 69 who were treated with alteplase. Participants were given a score of zero to 10 based on their age, glucose level, time since started, the severity of the stroke and other factors. The higher the score was, the more likely the person was to have a bad outcome three months later. A bad outcome was defined as being dead or being bedridden, incontinent and requiring constant and attention.

A total of 96 percent of those with scores of zero to two had a good outcome three months later. A good outcome was defined as being independent in daily activities. None of the people with DRAGON scores of eight to 10 had good outcomes three months later.

The score was also tested on a second group of 333 people at a hospital in Switzerland, with similar results.

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