Few Stroke Patients Given Clot-Buster Quickly Enough:
THURSDAY, Feb. 10 (HealthDay News) Few eligible stroke patients
get an injectable clot-busting drug within the recommended
60-minute window after their hospital arrival, new research
"It has been widely recommended that the 'door-to-needle' time should be 60 minutes," said study author Dr. Gregg C. Fonarow, a professor of cardiovascular medicine at the University of California Los Angeles David Geffen School of Medicine. The phrase refers to the timeframe between when the patient arrives at the hospital and when that patient is given the clot-buster, known as tissue plasminogen activator (tPA).
In his analysis of stroke patients from 1,083 hospitals, he
found the 60-minute window was not the typical reality. "That
occurs only in 26.6 percent of patients," he said.
Fonarow was slated to present the findings Thursday at the
American Stroke Association's International Stroke Conference in
Los Angeles; the research is being published simultaneously in the
Perhaps even more surprising, the hospitals in the study were
all participating in the American Heart Association/American Stroke
Get with The Guidelines-Stroke quality improvement program,
which recommends early tPA administration.
"It involved some of the largest, best-known hospitals for stroke care," Fonarow said.
The study looked at more than 25,500 patients who had suffered
ischemic stroke -- in which a blood clot obstructs blood flow --
and had been treated with tPA within three hours of the start of
Just 6,790 got the intravenous drug within 60 minutes. During
the course of the study, there was only modest improvement in the
hospitals' track records.
Fonarow's team found some differences in age, gender and race
when it came to who got the drug quickly and who did not. "Older
patients, women, blacks and Hispanics were less likely to be
treated in a timely manner," he said.
He also found that experience mattered. Hospitals that treated a
large number of stroke patients were more likely to administer the
drug within that 60-minute window.
Those who got the drug in under 60 minutes were also less likely
to die during their hospital stay than those who didn't. While only
8.6 percent of those who got the tPA within the ideal window died
while in the hospital, 10.4 percent of those who got the drug less
promptly did, the researchers said.
The results confirm other studies suggesting that busier stroke
centers do better with stroke care, said Dr. Patrick Lyden, chief
of neurology at Cedars-Sinai Medical Center in Los Angeles, who
reviewed the findings but was not involved in the research.
The same has held true, he said, for heart surgery and hip
replacement surgery. "Busier places do better," he said. "The next
step is to get patients to the busiest stroke centers faster."
First approved by the U.S. Food and Drug Administration in 1996,
tPA is used to treat ischemic stroke within the first three hours
after the onset of symptoms, with certain conditions in a stroke
patient ruling out its use. While doctors must decide who is and
isn't a candidate for tPA, loved ones can do much to speed up
treatment if a stroke occurs in a family member or friend, Fonarow
"Call 911 without delay," Fonarow said. Don't try to drive a patient to the hospital, he tells loved ones; rather, order an ambulance. Time lost is brain lost, Fonarow and other neurologists caution.
Get with the Guidelines-Stroke program is supported in part
by the American Heart Association Pharmaceutical Roundtable and the
Bristol-Myers Squib/Sanofi Pharmaceutical Partnership. Fonarow
reports receiving research support from the National Institutes of
Health and serving as a consultant to Pfizer, Merck and other
To learn more about tPA, visit the
American Heart Association.
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