Study examines safety and efficacy of TPA in mild stroke cases

July 10, 2018, University of Cincinnati Academic Health Center
A blood clot forming in the carotid artery. Credit: copyright American Heart Association

While the gold standard for stroke care is the use of IV tissue plasminogen activator (tPA, or product name Alteplase) to dissolve clots and mechanical thrombectomy to remove clots in severe to moderate strokes, researchers and clinicians have found it more difficult to align on a standard of treatment for mild strokes.

A national study looking at IV treatment of , led by researchers at the University of Cincinnati (UC) College of Medicine, is published in the July 10, 2018 edition of the Journal of the American Medical Association.

Based on epidemiological data from the well-known Greater Cincinnati Stroke Study, about one-third of strokes are classified as mild stroke. Pooja Khatri, MD, professor of neurology at UC, and lead author on the study, wanted to determine if treatment with Alteplase showed benefit when extended to mild stroke.

Results of the study showed that use of tPA for mild stroke may not be as beneficial to the patient as was hypothesized.

"Mild stroke is the most commonly cited reason for deciding to not start tPA among who arrive to a hospital within the treatment window. But we also knew that after 90 day follow-ups, up to 30 percent of these patients would suffer from some kind of functional disability," says Khatri, who is also director of acute for UC Health.

"In this study, we wanted to evaluate the efficacy and safety of using tPA to treat patients of ischemic stroke only presenting with minor deficits, judged as not clearly disabling," says Khatri. "In Greater Cincinnati, I think our approach has been more conservative; we weren't always treating with alteplase (tPA), while some centers have been treating them very aggressively. Previous trials excluded these patients, so individual clinicians and stroke teams had to make their own clinical judgments about treatment." Khatri engaged with leaders at across the country to better understand the treatment approaches for mild stroke.

The study used the National Institutes of Health Stroke Scale (NIHSS), which assesses stroke severity based on things like the patient's level of consciousness, facial droop and motor skills. A mild stroke is classified as 0 to 5, along with no clearly disabling deficits at time of presentation.

However, the trial ended early due to slower-than-expected enrollment. Outcomes for 313 patients were tracked and reported in this study, which does give researchers some evidence to consider when encountering mild stroke.

"Among the patients with minor, not clearly-disabling acute , what we found is with alteplase (compared with aspirin) did not increase the likelihood of a favorable functional outcome after 90 days," Khatri says.

She adds that the research team had hoped tPA would be beneficial in patients with a very mild neurological deficit.

"While the early termination does lead to uncertainty in the results, based on the data, it appears unlikely that the benefits of tPA extends to patients with mild stroke who do not present clearly disabling deficits," says Khatri, adding that this data provides additional information to physicians who treat stroke, and at some centers will be "practice-changing."

"[Here at UC] we were already on the side of not treating, but it is a bit more clear-cut to me now."

The study was funded by Genentech, makers of Alteplase. Khatri cites no conflict of interest.

Any stroke can have life-changing consequences, so it's important to identify the signs of a which can be remembered with the mnemonic FAST: If you see Facial drooping, Arm weakness, or Speech is slurred, Time to call 911.

Explore further: In mild strokes, ultra-early treatment may eliminate risk of disability

Related Stories

In mild strokes, ultra-early treatment may eliminate risk of disability

August 22, 2013
In the case of mild or moderate strokes, getting treatment ultra-fast – within 90 minutes of experiencing symptoms – greatly reduces the risk of suffering disability, according to a new study reported in the American ...

A better clot-buster drug for strokes?

April 26, 2018
(HealthDay)—After a stroke, many patients are given the clot-busting intravenous drug alteplase, but another drug may be more effective, Australian researchers report.

Stroke prevention drug combo shows promise, study says

May 16, 2018
If you've had a minor stroke or a transient ischemic stroke (TIA), taking the clot-preventing drug clopidogrel along with aspirin may lower your risk of having a major stroke within the next 90 days, according to new research ...

Ischemic stroke patients not receiving life-saving treatment, study finds

October 5, 2017
Ischemic stroke patients who do not receive intravelous (IV) alteplase, a clot-dissolving medication, are significantly less likely to survive, according to researchers at Georgia State University.

Low-dose alteplase no better for acute ischemic stroke

October 3, 2017
(HealthDay)—For key demographic subgroups of patients with acute ischemic stroke (AIS), low-dose alteplase does not differ from standard-dose alteplase in terms of treatment effects on death or disability, according to ...

Recommended for you

Bypass beats stents for diabetics with heart trouble: study

November 13, 2018
(HealthDay)—People with both diabetes and multiple clogged heart arteries live longer if they undergo bypass surgery rather than have their blood vessels reopened with stents, according to follow-up results from a landmark ...

Heart failure patients shouldn't stop meds even if condition improves: study

November 13, 2018
(HealthDay)—There's bad news for heart failure patients with dilated cardiomyopathy who'd like to stop taking their meds.

Kawasaki disease: One disease, multiple triggers

November 12, 2018
Researchers at University of California San Diego School of Medicine, Scripps Institution of Oceanography, and international collaborators have evidence that Kawasaki Disease (KD) does not have a single cause. By studying ...

New treatment significantly reduces cardiovascular events when combined with statins

November 12, 2018
Statins are the most commonly used treatment for cardiovascular disease. Despite reducing certain risk factors, if triglyceride levels remain high with use of statins, there is still a significant risk for heart attack, stroke ...

Study: How vitamin D and fish oil affect risk of heart attack, stroke and cancer

November 12, 2018
For years, it's remained an open question: What effects do dietary supplements such as high doses of vitamin D or omega-3 fatty acids derived from fish oil have on the risk of diseases such as heart attack, stroke and cancer? ...

Diabetes drug might also ease heart failure risks

November 12, 2018
(HealthDay)—The diabetes drug Farxiga might do double-duty for patients, helping to ward off another killer, heart failure, new research shows.

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.