Anti-Clotting Drugs May Help Up to 4.5 Hours After Stroke

With stroke, time lost is brain lost. Every minute that passes without treatment increases the odds of permanent disability. The use of the clot-busting drug tPA is currently limited to patients who meet specific criteria — including being treated within three hours of the onset of stroke symptoms, since prior studies failed to show that the drug is helpful when given after a longer time has passed. A new study, however, indicates that some patients may still benefit from receiving the drug up to 4.5 hours after symptoms began. This finding may change how stroke patients are treated when they arrive at the hospital.

The study, which was published in the New England Journal of Medicine, found that 52 percent of the group receiving the clot-dissolving drug for ischemic stroke between three and four-and-a-half hours after the initial onset of symptoms did well compared with just 45 percent of the placebo group. That 7 percent difference is significant and clinically meaningful. Nevertheless, receiving treatment as early as possible remains essential.

Suspect Stroke? Get Help Fast

I spoke with Larry B. Goldstein, MD, director of the Duke Stroke Center about the study. He warned me that it is vital that no one should take this study as evidence that it’s okay to take your time getting to the hospital if you suspect stroke. Time remains of the essence when it comes to successful stroke treatment: The faster you get treated, the greater the likelihood you’ll survive without significant disability.

Also, Goldstein pointed out that the study focused on a specific group — stroke patients who did not also have a prior history of stroke and diabetes, whose strokes were not considered severe and who were younger than 80 years old. Since these types of patients were excluded from the study, there is no data to indicate that treatment is either safe or effective for them. Goldstein stresses the need for prompt treatment for everyone: “When stroke symptoms begin, get to the hospital as quickly as possible.”

Use “Give Me 5” as a way to remember some common stroke symptoms:

1.  WALK — Is balance off?

2.  TALK — Is speech slurred?

3.  REACH — Is one side weak or numb?

4.  SEE — Is vision all or partially lost?

5.  FEEL — Is there a severe headache?