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

January 31, 2013

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:

  • Multidisciplinary quality improvement (QI) committees should be created within hospitals to review and monitor quality. "We now have dozens of studies showing the benefit of QI programs," Jauch said.
  • Recently introduced stent retrievers could potentially remove large blood clots more completely and quickly than tPA. But the devices shouldn't be a substitute for intravenous tPA and should only be used in clinical studies to determine if they improve patient outcomes.
F.A.S.T. is an easy way to remember the sudden signs of a stroke:
  • Face drooping: Does one side of the face droop or is it numb?
  • Arm weakness: Is one arm weak or numb?
  • Speech difficulty: Is speech slurred, are you unable to speak, or are you hard to understand?
  • Time to call 9-1-1: If you have any of these symptoms, even if the symptoms go away, call 9-1-1 and get to the hospital immediately.

Explore further: Clot-busting drug safe for stroke patients taking blood thinner

Related Stories

Clot-busting drug safe for stroke patients taking blood thinner

May 10, 2012
Acute ischemic stroke patients taking the blood thinner warfarin can be treated safely with the clot-busting drug tissue plasminogen activator (tPA), according to research presented at the American Heart Association's Quality ...

The Medical Minute: Solitaire for stroke -- It's not a game

May 22, 2012
Stroke is the fourth leading cause of death in North America -- down from third. Despite this "improvement," stroke remains the leading cause of adult disability. Ischemic strokes, caused by blood vessel blockages, are by ...

Use of clot busters for stroke increased from 2005 to 2009, but still low

June 2, 2011
The use of clot-busting drugs to treat acute ischemic stroke increased from 2005 through 2009 — but is still low, according to research reported in Stroke: Journal of the American Heart Association.

Recommended for you

Five vascular diseases linked to one common genetic variant

July 27, 2017
Genome-wide association studies have implicated a common genetic variant in chromosome 6p24 in coronary artery disease, as well as four other vascular diseases: migraine headache, cervical artery dissection, fibromuscular ...

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

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.