Although use of the clot-dissolving drug tissue plasminogen activator (tPA) has revolutionized the treatment of acute stroke patients, many of those who could receive the drug do not because their initial symptoms appear mild or improve soon after they arrive at the hospital.
Now a study from Massachusetts General Hospital (MGH) confirms previous observations that eligible patients who do not receive tPA face a significant risk of disability. The report will appear in the November issue of Stroke and is receiving early online release.
"Our primary finding was that about 30 percent of those patients judged 'too good to treat' either died or were discharged to a rehabilitation facility," says Eric Smith, MD, FRCPC, of MGH Neurology, the study's lead author. "Unfortunately we were not able to find any features that could predict which of the untreated patients would have problems."
When a stroke is caused by a blocked blood vessel, tPA can safely dissolve the clot if given within three hours of symptom onset, sometimes completely reversing the effects of the stroke. Many patients do not arrive at a hospital soon enough to receive the drug, but even when they do, physicians must weigh the small but significant risk that tPA treatment could cause a brain hemorrhage, a potentially devastating complication. Because of this risk, patients with less severe symptoms may not receive tPA in the hopes that they will get better on their own. An observation from an earlier study suggested that many of those patients would not do well and led to the current investigation.