People having stroke should get therapy within 60 minutes of hospital arrival

January 31st, 2013 in Cardiology /

People having an ischemic stroke should receive clot-dissolving therapy – if appropriate—within 60 minutes of arriving at the hospital, according to new American Stroke Association guidelines published in the American Heart Association journal Stroke.

Ischemic stroke, which accounts for nine in 10 strokes, is caused by a blood clot in the arteries leading to the brain. Calling 9-1-1 immediately after recognizing any of the warning signs of stroke—and getting to a stroke center as fast as possible—are still the most important steps for optimal stroke care.

During an acute stroke, physicians must quickly evaluate and diagnose the patient as soon as possible to determine if patients are eligible to receive the clot-dissolving drug recombinant (tPA), which must be given 4.5 hours within hours of . The goal is to minimize "door to needle" time which provides the patient with the best opportunity for benefit from the treatment.

"tPA can now be considered for a larger group of patients, including some those who present up to 4.5 hours from stroke onset," said Edward Jauch, M.D., lead author of the guidelines and director of the Division of Emergency Medicine at the Medical University of South Carolina.

The new guidelines recommend integrating regional networks of comprehensive stroke centers (which offer 24/7, highly specialized treatment for all types of stroke); primary (which provide 24/7 mainly for ); and -ready hospitals (which can evaluate and treat most strokes but lack highly specialized capabilities), and .

"This is the first time we've brought these healthcare elements together —, including community hospitals which may lack onsite stroke expertise, which reflects the emerging role of telemedicine in these hospitals," Jauch said.

Among other major revisions to the guidelines, if feasible, patients should be rapidly transferred to the closest available certified primary care stroke center or comprehensive stroke center, which might involve air medical transport. "However, for patients brought to hospitals without specialized stroke expertise, telemedicine can provide real-time access to expertise," Jauch said. "If such a hospital partners with a primary or comprehensive stroke center and uses telemedicine, early treatment decisions can be made for patients. If the patient had to be transferred before administering some therapies, it would be too late."

Other key recommendations in the new guidelines include:

F.A.S.T. is an easy way to remember the sudden signs of a stroke:

Provided by American Heart Association

"People having stroke should get therapy within 60 minutes of hospital arrival." January 31st, 2013. http://medicalxpress.com/news/2013-01-people-therapy-minutes-hospital.html