Research Reconfirms Early Treatment with t-PA Best for Stroke Patients

The importance of starting the clot-busting drug t-PA as quickly as possible after stroke onset was demonstrated by a combined analysis of six previous stroke trials that appears in the March 6 issue of The Lancet.  The analysis was co-authored by Joseph Broderick, MD, chairman of the Department of Neurology at the University of Cincinnati (UC) Medical Center, and co-director of the Greater Cincinnati/Northern Kentucky Stroke Team.

The combined analysis found that patients treated with t-PA within 90 minutes of stroke onset were 3 times more likely to get back to normal or near normal at three months following stroke, as compared to patients treated with placebo.  Patients treated within 90-180 minutes after onset were 1.5 times more likely to have an excellent outcome.  In addition, the analysis indicates that the chance of benefiting from early stroke treatment with t-PA may extend beyond three hours after the onset of stroke.

"This combined analysis emphasizes that every minute counts in the treatment of acute stroke," said Dr. Broderick.  "Delay of treatment by an hour was associated with a halving of the benefit of t-PA.  We are encouraged by the finding that t-PA's benefit may extend beyond three hours from onset.  This finding is currently being explored in several large ongoing trials outside North America."

Results of the six trials also indicated that patients suffering more severe strokes were more likely to get to the hospital early, while those with mild stroke symptoms took longer to get to the hospital. 

"The most important current task for all of us who do stroke research and care for stroke patients is educating the public to recognize stroke symptoms and to call 911 as quickly as possible," said Arthur Pancioli, MD, vice-chairman of the UC Department of Emergency Medicine, and co-director of the Greater Cincinnati/Northern Kentucky Stroke Team.

The analysis includes data from two trials organized by the National Institute for Neurological Disorders and Stroke (NINDS), in which the University of Cincinnati participated; two ATLANTIS (Alteplase ThromboLysis for Acute Noninterventional Therapy in Ischemic Stroke) Trials; and two ECASS (European Cooperative Acute Stroke Study) Trials.