Featured Research

from universities, journals, and other organizations

Improvements within one hour of stroke treatment associated with better outcomes

Date:
November 8, 2010
Source:
JAMA and Archives Journals
Summary:
Patients with stroke who experience improvement within one hour of receiving the clot-dissolving medication tissue plasminogen activator appear more likely to do well three months later, according to a new study.

Patients with stroke who experience improvement within one hour of receiving the clot-dissolving medication tissue plasminogen activator appear more likely to do well three months later, according to a report in the November issue of Archives of Neurology.

Only one effective therapy has been approved for acute ischemic stroke (in which blood flow to an area of the brain is blocked or reduced), according to background information in the article. Within 4.5 hours of developing symptoms, patients receive an intravenous (IV) dose of the medication recombinant tissue plasminogen activator, which helps to break up clots in the blood vessels. "However, not all patients respond to IV therapy; failure to respond to IV therapy is usually, but not always, associated with occlusion of large arteries and lack of recanalization [the formation of new blood vessel paths around the obstruction]," the authors write. "Additional IV thrombolysis [clot-dissolving] therapies, such as chemical and/or mechanical intra-arterial therapy, represent a promising approach to obtaining recanalization and better recovery."

Ioan-Paul Muresan, M.D., and colleagues at Assistance Publique -- Hτpitaux de Paris, France, analyzed 120 patients with acute ischemic stroke who were treated with IV recombinant tissue plasminogen activator between Nov. 11, 2002, and Dec. 24, 2007. Individuals were classified as having very early neurologic improvement at one hour if they had a National Institute of Health Stroke Scale score of zero at the end of medication administration or if their score had improved five or more points (on a severity scale of zero to 30) compared with the beginning of therapy.

Of the 120 patients, 22 (18.3 percent) had very early neurologic improvement. After three months, 15 of these patients (68.2 percent) had a favorable outcome as assessed by a scale measuring disability following stroke, compared with 29 patients without early improvement (29.6 percent). None of the patients with very early improvement died, compared with 17.3 percent of other patients.

Asymptomatic brain bleeding occurred in two patients with early improvement (9.1 percent) and in 23 patients without early improvement (23.5 percent). Symptomatic brain bleeding occurred in five patients (4.2 percent), none of whom showed early improvement.

"A promising new approach in the treatment of acute ischemic stroke is bridging therapy with a dual approach: IV thrombolysis by recombinant tissue plasminogen activator followed by chemical or mechanical endovascular therapy," the authors write. "Our results suggest that very early neurologic improvement, as determined by a clinical routine tool (National Institutes of Health Stroke Scale) at a patient's bedside, might help to rapidly select patients who will not respond to IV recombinant tissue plasminogen activator but who could be candidates for bridging therapy."

Editorial: Findings Intriguing, but Require Confirmation

"Evidence-based rationale for the treatment of acute ischemic stroke has accumulated during the last 15 years," writes Josι Biller, M.D., of Loyola University Chicago, in an accompanying editorial. "Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency management of acute ischemic stroke and the only therapy for acute ischemic stroke approved by the Food and Drug Administration."

"Understanding how baseline clinical, biological and imaging variables affect outcome is critical for the subsequent treatment of patients with acute ischemic stroke and future acute stroke clinical trials design."

"Muresan and colleagues' attempt to answer an interesting question suggest that a quick bedside assessment with the National Institute of Health Stroke Scale can predict good response and conversely, that it can predict poor responders so that the treating physician can begin consideration of mechanical interventions intra-arterial therapy or other alternative therapies."

"As pointed out by the authors, this is a single-center study that needs to be reproduced," Dr. Biller concludes. "Clearly, additional studies involving larger populations with a multicenter design are needed to address the significance and clinical utility of the intriguing findings of this carefully conducted study by Muresan and colleagues."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. I.-P. Muresan, P. Favrole, P. Levy, F. Andreux, B. Marro, S. Alamowitch. Very Early Neurologic Improvement After Intravenous Thrombolysis. Archives of Neurology, 2010; 67 (11): 1323 DOI: 10.1001/archneurol.2010.265
  2. J. Biller. The Sooner, the Better. Archives of Neurology, 2010; 67 (11): 1306 DOI: 10.1001/archneurol.2010.276

Cite This Page:

JAMA and Archives Journals. "Improvements within one hour of stroke treatment associated with better outcomes." ScienceDaily. ScienceDaily, 8 November 2010. <www.sciencedaily.com/releases/2010/11/101108161129.htm>.
JAMA and Archives Journals. (2010, November 8). Improvements within one hour of stroke treatment associated with better outcomes. ScienceDaily. Retrieved July 28, 2014 from www.sciencedaily.com/releases/2010/11/101108161129.htm
JAMA and Archives Journals. "Improvements within one hour of stroke treatment associated with better outcomes." ScienceDaily. www.sciencedaily.com/releases/2010/11/101108161129.htm (accessed July 28, 2014).

Share This




More Health & Medicine News

Monday, July 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Deadly Ebola Virus Threatens West Africa

Deadly Ebola Virus Threatens West Africa

AP (July 28, 2014) — West African nations and international health organizations are working to contain the largest Ebola outbreak in history. It's one of the deadliest diseases known to man, but the CDC says it's unlikely to spread in the U.S. (July 28) Video provided by AP
Powered by NewsLook.com
$15B Deal on Vets' Health Care Reached

$15B Deal on Vets' Health Care Reached

AP (July 28, 2014) — A bipartisan deal to improve veterans health care would authorize at least $15 billion in emergency spending to fix a veterans program scandalized by long patient wait times and falsified records. (July 28) Video provided by AP
Powered by NewsLook.com
Two Americans Contract Ebola in Liberia

Two Americans Contract Ebola in Liberia

Reuters - US Online Video (July 28, 2014) — Two American aid workers in Liberia test positive for Ebola while working to combat the deadliest outbreak of the virus ever. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
Traditional African Dishes Teach Healthy Eating

Traditional African Dishes Teach Healthy Eating

AP (July 28, 2014) — Classes are being offered nationwide to encourage African Americans to learn about cooking fresh foods based on traditional African cuisine. The program is trying to combat obesity, heart disease and other ailments often linked to diet. (July 28) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins