Nearly two decades after the approval of a clot-busting drug that can prevent serious disability after a stroke, only about 4% of stroke patients are actually receiving the drug, a new study shows.
"We are not making a great deal of progress," says the study's lead author, Opeolu Adeoye, an associate professor of emergency medicine and neurosurgery at the University of Cincinnati.
The medication, called tPA, or tissue plasminogen activator, can dissolve the blood clots that cause most strokes, often sparing patients from devastating brain damage. The drug increases the chance that a stroke patient will be able to regain normal functions and return home by about 30%, Adeoye says.
But tPA, approved for strokes in 1996, only works if given within 4.5 hours of a stroke. Hospitals have worked to streamline their systems to get patients care as quickly as possible, says Victor Urrutia, medical director of the comprehensive stroke center at Johns Hopkins Hospital in Baltimore, who wasn't involved in the new study. Yet, he says, "It's really striking that this number hasn't increased much over the years."
About 795,000 Americans suffer a stroke each year, according to Johns Hopkins.
Yet Adeoye found that tPA — the only drug approved by the Food and Drug Administration for an acute stroke — should be within reach of most Americans, according to a new study presented Thursday at the American Stroke Association's International Stroke Conference in San Diego. More than 80% of Americans live within an hour's drive of a hospital equipped to administer tPA, which is given intravenously, Adeoye says. Yet more than 60% of hospitals didn't give any tPA at all in 2011, he says.
"Although there have been improvements in care, this study shows we have a long way to go," says Shazam Hussain, head of the stroke center at the Cleveland Clinic, who wasn't involved in the new study.
Before giving tPA, doctors need to perform a CT scan to confirm that a patient's stroke is caused by a blood clot — which kills brain tissue by depriving them of oxygen – rather than by bleeding, says Robert Brown, a professor and chairman of neurology at the Mayo Clinic in Minnesota, who wasn't involved in the new study. Giving a clot-busting drug to someone whose stroke is caused by bleeding could be fatal.
Thanks to hospitals' improvement efforts, doctors today do a better job of ordering CTs quickly and getting them read, Brown says.
Ambulance crews need to do a better job in routing stroke patients to stroke centers, rather than taking them to the closest hospital, Adeoye says.
Patients and family members also need to change how they respond to strokes, Brown says. Many patients fail to recognize that they're having a stroke and need immediate care, Brown says. In some cases, that could be because the symptoms of a stroke aren't obvious. And some people may delay calling 911 because they don't realize that effective treatment exists. But every minute of delay increases the risk of permanent brain damage and disability. Brown urges people to call 911 immediately and take an ambulance to the hospital. That way, ambulance crews can call ahead to hospitals to alert the stroke team.
According to the Mayo Clinic, symptoms of a stroke include trouble speaking, seeing or walking; paralysis or numbness of the face, hands or legs; and intense headache.
"When symptoms come on, people tend to ignore them," Brown says. "They tend to wait and just hope it goes away."
Adeoye presented his research in abstract form, and has not yet published the paper in a peer-reviewed journal.