Stroke specialists offer guidance on questions about thrombolytic therapy use

One of the most challenging issues in stroke care involves the use of clot-busting drugs such as tPA.

When given quickly enough and to the right patient, such drugs can minimize stroke damage by dissolving blood clots that cause most strokes. But these blood-thinning drugs also increase the risk of brain hemorrhages and other complications.

In an article in the journal Expert Review of Neurotherapeutics, Loyola University Medical center stroke specialists offer guidance on commonly asked questions about the use of these drugs, known as thrombolytic therapy.

The authors are H. Steven Block, MD and Jose Biller, MD. Block, a neurologist with 30 years experience, is doing a fellowship at Loyola in cerebrovascular disease research. Biller is professor and chair of the Department of Neurology of Loyola University Chicago Stritch School of Medicine.

Most strokes are caused by blood clots that block blood flow to a portion of the brain. If given within 4.5 hours of the onset of a stroke, drugs such as tPA can reduce damage by restoring blood flow to the affected part of the brain. In various circumstances, neurologists must weigh the benefits of tPA against the risks of hemorrhage and other complications.

These are among the questions Block and Biller address in their article:
•Can thrombolytic therapy be administered in a patient with an aneurysm (bulging blood vessel) in the brain that hasn't ruptured?

•Is it safe to use thrombolytic therapy in a stroke patient following a recent heart attack?

•Is there a standard, defined therapy for a stroke that occurs during or immediately after a cardiac catheterization?

•Can thrombolytic therapy be used in stroke patients with brain tumors?

"These are examples of the type of nuanced circumstances that neurologists face," Block said.

Block and Biller write that the next five years should bring continued advances in stroke care.

"Large multicenter prospective randomized controlled trials will move us closer to increasing confidence of the efficacy of specific treatments," they write. However, the most important advance in reducing the incidence of stroke will "continue to remain one of the most challenging to achieve: acceptance by the population to take personal responsibility for their own stroke risk reduction."