Public release date: 18-Jun-2013 [ | E-mail | Share ]
Contact: Mark Wheeler mwheeler@mednet.ucla.edu 310-794-2265 University of California - Los Angeles
For years, the mantra of neurologists treating stroke victims has been "time equals brain." That's because getting a patient to the emergency room quickly to receive a drug that dissolves the stroke-causing blood clot can make a significant difference in how much brain tissue is saved or lost.
But specific information has been limited on just how the timing of giving the intravenous drug known as a tissue plasminogen activator, or tPA influences outcomes for victims of ischemic (clot-caused), stroke, the most common type of stroke.
Now, a team led by UCLA researchers has conducted a major study on the importance of the speed of treatment when using tPA, analyzing outcomes for more than 50,000 stroke patients and determining just how critical the time between the onset of stroke and the administering of treatment is.
"We found that treatment time has a profound influence on outcome," said the study's first author, Dr. Jeffrey Saver, a professor of neurology and director of the UCLA Stroke Center. "The sooner treatment is started, the better. Beginning treatment earlier resulted in an improved ability to walk, the ability to remain living independently, less bleeding in the brain and reduced mortality."
The team's findings are reported in the June 19 issue of the JAMA, The Journal of the American Medical Association.
Previous research had demonstrated that administering tPA intravenously up to 4.5 hours after a stroke occurs benefits patients with moderate to severe acute ischemic stroke. Data pooled from a number of small, randomized clinical trials showed that the benefit of tPA was greatest when given very early after stroke, and that the benefit declined throughout the first 4.5 hours.
But the available data from these clinical trials was small just 1,850 tPA-treated patients from eight trials limiting precision in delineating the influence of time-to-treatment, as well as researchers' ability to determine whether the benefits could be generalized to a wider population. To address this need, the current study used a large national registry to determine more precisely the association of time-to-treatment and the resulting outcomes.
The team, which included UCLA's Dr. Gregg C. Fonarow, a professor of cardiovascular medicine and the director of the AhmansonUCLA Cardiomyopathy Center, analyzed data from the national stroke care quality-improvement database maintained by the American Heart Association/American Stroke Association's Get With the GuidelinesStroke program (GWTGStroke). They looked at the relationship between the time of treatment and in-hospital outcomes for 58,353 acute ischemic stroke patients treated with tPA within 4.5 hours of stroke onset.
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Timely treatment after stroke is crucial, UCLA researchers report