Jefferson University Hospitals

Earlier this year, an advisory committee of the American Stroke Association/American Heart Association issued a recommendation that the window of time for tissue plasminogen activator (tPA) therapy be extended.

The new analysis shows that the medication, which is given intravenously, can safely be used to treat strokes 4.5 hours after symptoms begin. Until this year, tPA had to be given within three hours of symptom onset.

As Jefferson Vascular Neurologist Carissa Pineda, MD, explains, tPA is the only FDA-approved drug for treating the 80 percent of strokes caused by ischemic clots. (The other major type – hemorrhagic stroke – is caused by ruptured blood vessels in the brain. Hemorrhagic stroke cannot be treated with tPA and has a much higher mortality rate than ischemic stroke.)

“tPA can be thought of as a ‘clot buster,’” Dr. Pineda notes. “Once it reaches the clot, it bursts it – limiting the areas of the brain that would have been affected.”

But as Dr. Pineda notes, the original guidelines required the clot-busting drug to be administered within three hours of the onset of symptoms. Even in top-performing hospitals, less than 5 percent of stroke patients are treated in that timeframe.

The new guideline – based on analysis of clinical studies – enables emergency-room physicians and stroke specialists to give tPA up to 4.5 hours after the onset of symptoms.

When stroke symptoms strike, don’t delay
For anyone who has a stroke, time lost is brain lost, explains Dr. Pineda.

“In a person having an ischemic stroke, 2 million neurons die every minute,” she says. “When symptoms appear, it’s vital to get to the hospital immediately.”

Unfortunately, as Dr. Pineda explains, stroke symptoms are often confused with other conditions – many of which seem “trivial.” She says it’s not uncommon for stroke victims to mistake their nausea and dizziness for gastrointestinal issues. They may attribute blurred vision to the need for stronger eyeglasses, or chalk up numbness on one side of their body to “sleeping funny.” What’s more, loved ones sometimes assume an individual’s inability to speak or walk steadily is due to intoxication.

Any and all of these mistakes in judgment can add up to tragedy, Dr. Pineda says.

“When you wait 10 hours to come to the emergency room, you’ve missed the old and new window for receiving the clot-busting drug,” she explains. “It’s critically important for people to know the signs of stroke and react to them very quickly – ideally, within 60 minutes of onset.”

Watch for these signs and symptoms
If you aren’t sure what to watch for, review this list of signs and symptoms and consider posting it somewhere you can easily refer to it:

• Sudden weakness and/or numbness in one side of the body
• Facial droop on one side
• Difficulty speaking or understanding words
• Sudden loss of vision
• Sudden, severe headache
• Sudden nausea and/or vertigo
• Loss of balance and coordination

“If you or a loved one experience any of those symptoms, don’t automatically write it off as something ‘minor,’” Dr. Pineda concludes. “Seek medical attention right away. The only medication that’s available can work only within a limited time window.”