Researchers fine-tune clot-busting treatment for bleeding in brain

May 14, 2008

A multicenter study led by Johns Hopkins doctors has fine-tuned the dosage and timing for administering clot-busting tissue plasminogen activator (tPA) to patients with strokes caused by bleeding within the brain. The treatment, as reported this week at the European Stroke Conference in Nice, France, has been shown to dramatically decrease death and disability in patients with this typically lethal subset of stroke.

"We've gone from what's usually an 80 percent death rate in patients with this condition to an 80 percent survival rate," says study leader Daniel Hanley, M.D., professor of neurology at the Johns Hopkins University School of Medicine.

This condition, known as intracerebral hemorrhage (ICH), causes blood to clot inside the brain's interior cavities, building up pressure within the brain. The higher pressure, along with inflammation caused by chemicals in the trapped blood, can irreversibly damage the brain, usually leading to death or extreme disability. Until recently, Hanley notes, no treatment existed for this subset of stroke.

The new research builds on a series of previous studies designed to test the safety and efficacy of clot-busting drugs in patients with ICH. This treatment, developed by Hanley and his colleagues, clears the trapped blood out of the brain by bathing-and dissolving-the clot directly in tPA. This drug normally isn't recommended for conditions that involve bleeding, such as ICH, because it can increase the risk of further hemorrhage. However, since high-dose (80 to 100 mg) tPA is effective at breaking up clots in other conditions, such as heart attacks and other types of strokes, Hanley and his colleagues wondered whether very low doses of the drug might be a safe and effective way to treat ICH.

The previous studies showed that giving tPA to ICH patients hadn't significantly increased bleeding or death, so in the latest study, Hanley and his colleagues sought to determine the safest and most effective treatment regimen using this drug.

At 20 hospitals located across the United States, Canada, Great Britain, and Germany, the researchers recruited 52 patients recently diagnosed with ICH. All of the patients had received the usual treatment for this condition, placing a catheter inside the brain to release the trapped blood. Using the same catheter as a conduit for flooding tPA directly onto the clot, the researchers put each patient on one of three treatment regimens: 0.3 milligrams of the drug every 12 hours, 1 milligram of the drug every 12 hours, or 1 milligram of the drug every 8 hours.

Tracking patients' progress with daily CT scans, the researchers found that the clots dissolved within three to four days on average, with patients on 1 milligram of tPA every 8 hours dissolving their clots about a day faster than those on the other treatment regimens. This timing is about two to three times faster than that of previous patients who didn't receive tPA. Hanley notes that additional bleeding among all the patients was minimal; those treated with tPA weren't any more likely to have additional hemorrhaging than those past patients who didn't receive the drug.

One month after treatment, more than 80 percent of the patients were alive, and 10 percent of these had recovered enough to return to their jobs, the researchers report.

"We think that this treatment is the most promising story in brain hemorrhage in many years," says Hanley. "We've taken a condition that used to have an extremely high rate of death and disability and turned it around."

Source: Johns Hopkins Medical Institutions

Explore further: Stroke patients experience superior outcomes with intra-arterial treatment vs. tPA

Related Stories

Stroke patients experience superior outcomes with intra-arterial treatment vs. tPA

December 17, 2014
Penumbra, Inc., the market leader in intra-arterial stroke treatment, announced that an independent study published online today in the New England Journal of Medicine found that intra-arterial stroke treatment, including ...

Having a stroke? Where you are makes a huge difference in your treatment

June 26, 2015
It looks like a crazy quilt spread over the continent. But a new map of emergency stroke care in America shows just how much of a patchwork system we still have for delivering the most effective stroke treatment.

Do blood thinners + stroke treatment = danger? Study indicates the risk is low

March 13, 2013
Millions of Americans take aspirin or other drugs every day to reduce their risk of heart attacks or other problems caused by blood clots.

Better stroke care, everywhere: Study boosts local hospitals' clotbuster use

December 20, 2012
From the moment a stroke occurs, patients must race against the clock to get treatment that can prevent lasting damage. Now, a new study shows the promise – and the challenges – of getting them state-of-the-art treatment ...

New research identifies key reasons racial disparities exist in emergent stroke treatment

June 30, 2011
African-Americans are less likely than whites to receive critical stroke treatment primarily because they do not get to a hospital soon enough for time-sensitive treatment and because of preexisting medical conditions. For ...

Stroke treatment, outcomes improve at hospitals participating in 'Target: Stroke' initiative

April 22, 2014
Administering a clot-dissolving drug to stroke victims quickly—ideally within the first 60 minutes after they arrive at a hospital emergency room—is crucial to saving their lives, preserving their brain function and reducing ...

Recommended for you

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

'bench to bedside to bench': Scientists call for closer basic-clinical collaborations

March 24, 2017
In the era of genome sequencing, it's time to update the old "bench-to-bedside" shorthand for how basic research discoveries inform clinical practice, researchers from The Jackson Laboratory (JAX), National Human Genome Research ...

The ethics of tracking athletes' biometric data

January 18, 2017
(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...

Financial ties between researchers and drug industry linked to positive trial results

January 18, 2017
Financial ties between researchers and companies that make the drugs they are studying are independently associated with positive trial results, suggesting bias in the evidence base, concludes a study published by The BMJ ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.