The clot-busting drug rt-PA remains the most beneficial proven
emergency treatment for strokes caused by blood clots, according to an
editorial in the November issue of Archives of Neurology by Dr. José
Biller.

"The benefits of treatment outweigh the risks in patients treated with
intravenous rt-PA within 4.5 hours of symptom onset," Biller wrote.
Biller is chairman of the Department of Neurology at Loyola University
Chicago Stritch School of Medicine and an internationally recognized
expert on stroke care.

Most strokes are ischemic, meaning they are caused by blood clots that
block blood flow in the brain. Brain cells begin dying when they are
starved of blood supply. But if administered soon enough, an IV drug
known as recombinant tissue plasminogen activator (rt-PA) can dissolve
clots, restore blood flow and limit damage.

Biller's editorial is about a study, published in the same issue, by
Dr. Ioan-Paul Muresan and colleagues at Assistance Publique --
Hopitaux de Paris. The study found that stroke patients who show
improvement within one hour of receiving rt-PA were more likely to do
well three months later,

Researchers followed 120 patients who received rt-PA and found that 22
(18.3 percent) showed significant improvement within one hour of
treatment. After three months, 15 of these patients (68.2 percent) had
a favorable outcome. By comparison, only 29.6 percent of patients who
did not show early improvement had a favorable outcome at three
months.

These findings suggest that a quick bedside assessment "can predict
good response," Biller wrote. Conversely, a poor response in the first
hour can predict a poor outcome at three months. In such cases,
physicians "can begin consideration of mechanical interventions,
intra-arterial therapy or other alternative therapies."

Additional studies involving larger populations at multiple centers
"are needed to address the significance and clinical utility of the
intriguing findings of this carefully conducted study," Biller wrote.

Provided by Loyola University Health System

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