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

How genes and environment interact to raise risk of congenital heart defects

October 19, 2017
Infants of mothers with diabetes have a three- to five-fold increased risk of congenital heart defects. Such developmental defects are likely caused by a combination of genetic and environmental factors. However, the molecular ...

Mouse studies shed light on how protein controls heart failure

October 18, 2017
A new study on two specially bred strains of mice has illuminated how abnormal addition of the chemical phosphate to a specific heart muscle protein may sabotage the way the protein behaves in a cell, and may damage the way ...

Newborns with trisomy 13 or 18 benefit from heart surgery, study finds

October 18, 2017
Heart surgery significantly decreases in-hospital mortality among infants with either of two genetic disorders that cause severe physical and intellectual disabilities, according to a new study by a researcher at the Stanford ...

Saving hearts after heart attacks: Overexpression of a gene enhances repair of dead muscle

October 17, 2017
University of Alabama at Birmingham biomedical engineers report a significant advance in efforts to repair a damaged heart after a heart attack, using grafted heart-muscle cells to create a repair patch. The key was overexpressing ...

Physically active white men at high risk for plaque buildup in arteries

October 17, 2017
White men who exercise at high levels are 86 percent more likely than people who exercise at low levels to experience a buildup of plaque in the heart arteries by middle age, a new study suggests.

High blood pressure linked to common heart valve disorder

October 17, 2017
For the first time, a strong link has been established between high blood pressure and the most common heart valve disorder in high-income countries, by new research from The George Institute for Global Health at the University ...

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.