Using clot buster for mild stroke could save millions
February 9th, 2011
01:11 PM ET

Using clot buster for mild stroke could save millions

Treating mild strokes with the blood-clot dissolving drug approved for severe strokes could save $200 million in annual disability costs and lower the number of patients left disabled after suffering strokes, a new study finds.

Strokes can be caused by a blood clot (ischemic) or a ruptured blood vessel (hemorrhagic) preventing proper blood and oxygen flow to the brain. The majority –about 87%– are ischemic, according to the American Stroke Association.

Tissue plasminogen activator (tPA) is the only drug approved by the FDA for treating ischemic stroke. It dissolves blood clots and, when given within 4.5 hours of the onset of symptoms, can prevent permanent disability in patients. But tPA can cause brain bleeding when given too late. While tPA is often used to treat moderate to severe strokes, its use for treating mild strokes is unproven, according to information provided by the American Stroke Association.

In the study presented at the American Stroke Association's International conference, University of Cincinnati researchers examined hospital records from 437 patients  with diagnosed mild ischemic stroke in the Cincinnati/Kentucky region in 2005. Patients arrived at the hospital within 3.5 hours—within the 4.5 hour window for tPA treatment. Less than 1% - only four patients—received tPA. The researchers found an additional 150 patients who might have also been treated with tPA if stroke mildness were not factored in to treatment plan.

When the researchers extrapolated their results to the U.S. population, they concluded that 2,176 to 3,761 fewer patients per year would be disabled after stroke if treated with tPA. They conclude that would save an estimated $200 million in disability costs per year.

“Currently, there is no standard of treatment for patients with the mildest strokes, even if they come into the emergency department quickly enough for intravenous tPA, the only proven treatment for a more serious stroke,” according to lead researcher Dr. Pooja Khatri of the University of Cincinnati Academic Health Center in Ohio.

Khatri explained that “it was believed that patients with milder strokes would recover from these events. These findings raise the question of whether the mildest strokes should be treated with intravenous tPA.”  She says that further studies are under way to examine the use of tPA for milder strokes.

Stroke is the No. 3 cause of death, after heart disease and cancer, and the leading cause of adult disability according to the American Stroke Association.

soundoff (9 Responses)
  1. Ronald Breeze

    In 2004 this drug allowed me to be alive today. It was used to dissolve a massive DVT that had broken up and caused a pulmonary embolus and two clots in my heart. Don't just think this drug is for strokes if I hadn't had a fast thinking doctor, who was not afraid to think outside convention, and this drug I wouldn't be here to write this.

    February 9, 2011 at 15:21 | Report abuse | Reply
  2. Michael

    This study is flawed for SO many reasons. Frankly, it's embarassing that anyone attempted to draw cost-of-disability conclusions. The reasons that t-PA isn't given to EVERY stroke patient is because of the relatively high risk of hemorrhage (which in the brain is a VERY BAD THING). This study removed every one of these patients by selecting only the patients diagnosed with "mild stroke." Clearly, if they had brain bleeding then the diagnosis would be something other than "mild stroke." So the assumptions of this study are that zero percent of the people getting the medicine will have that very debilitating side effect (actual number is closer to 5 percent). So for all we know, the medicine may prevent 2-4 thousand cases of disability due to ischemic stroke only to cause 20-40 thousand cases of disability due to brain hemorrhage.

    February 9, 2011 at 16:02 | Report abuse | Reply
    • Dr. Joe

      As an ER doc- Agree completely!

      February 9, 2011 at 17:40 | Report abuse |
    • Jessica

      This would be a good point.... but it's standard of care for stroke victims to get stat CTs to rule out acute bleed. It's not flawed because it only looked at "mild" strokes.... It's just the limited scope they attempted to study first for its use.

      February 9, 2011 at 23:20 | Report abuse |
    • DR. Pete

      while it is standard of care to get a stat head CT, Dr. Joes point is that the number needed to harm is going to be relatively few, if the symptoms are mild and the potential outcome (a secondary bleed) is potentially devastating- I imagine since the ischemic penumbra is smaller in these strokes, the vulnerable tissue most likely to bleed is smaller volume, but the whole issue is pretty dicy and it wasn't that long ago (5 years tops) that I was still talking patients out of TPA for strokes because the pendulum of patient opinion hadn't swung so far in favor of treatment as it is now. I have given up trying to make sense of the scanty literature versus the exaggerated claims of the drug companies and basically let the patients decide whether they want it or not. TPA for massive PE as described by the guy above though is a different story, and I brought back a 16 year old kid from a PEA arrest from massive PE affecting his good lung that struck as his parents were loading him into the car in the hospital lot after a 3 day hospitalization for a mycoplasma pneumonia with infiltrate mostly on the other side. Wild case and he walked out neurologically intact despite pulseless and CPR to circulate the TPA for about 15 minutes with sats that wouldn't get above 80-85% until the clot got lysed.

      February 10, 2011 at 00:42 | Report abuse |
    • Joseph Pearl

      Great Point.

      Joseph Pearl
      Bakersfield Disability Attorney

      February 28, 2011 at 23:14 | Report abuse |
  3. Chris Mitchell

    A Primary Stroke Center will use a proven algorithm and treatment protocol to determine the risk of each course of treatment, especially t-PA and neurointerventional care. The importance is considering the use of t-PA in other situations, within time limits, and best knowledge of patient history and contraindications. This is good news. Too many folks will not take the signs and symptoms seriously and avoid timely treatment. Time IS brain.

    February 9, 2011 at 16:56 | Report abuse | Reply
  4. Debbie White

    I lost my mom to a stroke in 2004 and I beleive today that had they gave her this drug she would be here today. She went in with a mild stroke and they said that she could bleed to death if they gave her this drug....She ended up being in the hospital 3 months, losing her speech and ability to walk and then losing the battle. I know this could have saved her, she was never gave the chance......

    February 9, 2011 at 19:13 | Report abuse | Reply
  5. Maggie

    Agreed on the poor study design. It is not fun to watch someone who was given this drug for equivocal reasons develop a big brain bleed and die. Many patients who come in with stroke symptoms resolve on their own or with mild anticoagulation (Aspirin, Aggranox). The drug companies that make these "clot busters" push it like crazy, and even have influenced the American Heart Association. Be careful when evaluating these studies that a drug company did not sponsor them. There is a 5-30% chance you will get a brain bleed big enough to kill you if you get these.

    February 9, 2011 at 21:26 | Report abuse | Reply

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