More time on the side of treating stroke

From the London (Ont.) Free Press:
The window for delivering critical clotbusting drugs after a stroke is slightly bigger than was thought, updated guidelines for stroke care suggest.

The revised best practice recommendations say the drugs, which can prevent or minimize the damage from a stroke, can be given within 4.5 hours of a stroke. Previous guidelines suggested the drugs had to be administered within three hours to be effective.

The larger window may mean more people who have strokes get care, a welcome development if it occurs.

It's estimated that less than a third of people who have had a stroke get drugs that can break up the blood clots clogging an artery and cutting off blood supply to a part of the brain.

If untreated within the optimal window, that damage becomes permanent and can lead to speech and motor difficulties and cognitive impairments.

It's why those who work in stroke medicine use the adage "time is brain."

Even though the new guidelines suggest there's more time than was thought, that shouldn't slow anyone's pace, suggested Dr. Stephen Phillips, head of the expert panel that revised the recommendations. ...more

Clot buster may be given later for strokes: study

From CBC News:
Stroke patients can safely be given a clot dissolving drug within 4.5 hours, an extension of the conventional three-hour window, a European study suggests. The longer timeframe may help patients who can't reach a hospital quickly to access specialist care.

An ischemic stroke occurs when a clot blocks a blood vessel in the brain and cuts off circulation, potentially causing death or permanent disability. Doctors give a drug called tissue plasminogen activator or tPA by intravenous to dissolve clogs lodged in the brain to treat the most common type of stroke.

Treatment guidelines in Canada, the U.S. and Europe set a three-hour time limit for giving tPA because of fears that it may cause dangerous bleeding or other complications.

Given safety concerns, European regulators requested further observational studies and a randomized clinical trial on tPA, also called alteplase.

In Monday's online issue of the medical journal The Lancet, Prof. Nils Wahlgren of the department of clinical neurosciences at Karolinska University Hospital in Stockholm and his colleagues reported no significant differences between subjects who were given the drug after three hours compared to four hours. ..more

Warfarin underused by patients at risk for stroke

This study comes as no surprise to anyone who has worked in an anticoagulation clinic. There are far too many people in the community not being properly managed on their warfarin, or aren't taking it when they should be.

From Reuters:
New research indicates that most patients with atrial fibrillation -- the most common type of heart arrhythmia -- who suffered a stroke and were eligible for anticoagulation treatment, were not taking any warfarin or were not taking enough.

"These are missed opportunities for stroke prevention," lead author Dr. David J. Gladstone, from the University of Toronto, said in a statement. "Sadly, we frequently see patients admitted to a hospital with a devastating stroke who are known to have atrial fibrillation, yet were either not taking warfarin or were taking a dose that is not therapeutic."

Warfarin, also known by the trade name Coumadin, can reduce the risk of stroke by preventing the formation of blood clots, which often occur in patients with atrial fibrillation. The clot may detach from the wall of the blood vessel and become lodged in the brain, blocking the flow of blood and causing a stroke. Atrial fibrillation doesn't always cause symptoms, but the condition can be quite dangerous.

As they reported in the current online issue of Stroke, the researchers analyzed data for 597 patients with known atrial fibrillation and potentially preventable strokes who were entered in the Registry of the Canadian Stroke Network from 2003 to 2007....more

In-hospital stroke patients more likely to die: study

From the Ottawa Citizen:
One of the worst places to be if you have a stroke is in a hospital, new Canadian research suggests.

A study based on thousands of Ontario residents found patients who have a stroke while they're already in hospital wait twice as long for a brain scan and twice as long for a clot-busting drug as people who come to an emergency room with a stroke. They are also more likely to die.

"You would think, naively, that if someone has a stroke while in hospital -- given that we keep emphasizing the concept that 'time is brain' and the sooner you get to treatment, the better -- you would anticipate that they would have the best treatment," says Dr. Frank Silver, co-principal investigator of the Registry of the Canadian Stroke Network and medical professor at the University of Toronto. ...more

Stroke therapy fights cell death

From the Globe and Mail:
In recent years, huge advances have been made in the treatment of the most common type of stroke in which a clot blocks the flow of blood to part of the brain.

If a patient gets to a hospital within three hours of the onset of symptoms, doctors can administer a clot-busting drug that quickly restores blood flow and reduces the chances of long-term disability.

But there is a catch: A lot of patients don't make it to an emergency room in time to receive this brain-preserving therapy.

A new study suggests there may be another option for the latecomers. People treated with the antibiotic minocycline within six to 24 hours of the stroke suffered far fewer long-term disabilities than patients who didn't get the medication. ...more