Experimental drug therapy could open new window for treatment of deadly stroke

A new type of drug therapy that is currently being tested in Canada could significantly reduce the death rate caused by the deadliest form of stroke. According to the Canadian Heart and Stroke Foundation, new developments in stroke research make it more important than ever that Canadians recognize and react to the warning signs of stroke.

Used to treat people with a bleeding disorder known as hemophilia, studies indicate that recombinant Factor VIIa (rFVIIa, or “rFactor7a”) can stop the bleeding in the brain associated with an intracerebral hemorrhage (ICH) and minimize additional damage if it is administered during the early stages of a hemorrhagic stroke . 

Like tissue plasminogen activator (tPA), the “clot-busting drug” used to treat ischemic stroke , rFVIIa seems to work best when given early after the onset of symptoms, a time when most of the ongoing bleeding occurs.

“Existing treatments like tPA, and potential new treatments for stroke, underline that it is critical that Canadians recognize the warning signs of stroke and act quickly by getting to an appropriate medical facility as soon as symptoms occur,” says Heart and Stroke Foundation spokesperson, Dr. Andrew Demchuk.  “The longer the delay, the greater the risk of permanent brain damage, disability and death. It is tragic when a patient ignores these serious signs and we miss an opportunity to help.”    

The Heart and Stroke Foundation estimates that intracerebral hemorrhages account for approximately 10 percent of all strokes that occur in Canada each year. “ Intracerebral hemorrhage is essentially like a bruise in the brain. Unfortunately early on this bruise can continue to grow and result in devastating injury to the brain,” says Demchuk.

These strokes can often affect younger individuals.  Four out of every 10 patients with intracerebral hemorrhage will die within 30 days, a toll that is more than double that of ischemic stroke (the most common type of stroke, caused by the blockage of a brain artery and subsequent death of portions of brain).  In 2002/03, there were 4,700 hospitalizations in Canada due to intracerebral hemorrhage and 1,800 deaths. 

In the Phase II safety trial that was just completed, rFVIIa cut the risk of death by 30 per cent and resulted in at least one more patient  in 10 fully recovering from their hemorrhage. “A second trial is about to commence to confirm the findings of the first study before the drug could be considered as a standard treatment in Canada,” says Demchuk, director of the Calgary Stroke Program involved in the international trial.  

The warning signs of intracerebral hemorrhage are similar to those of other types of strokes, although the symptoms, such as paralysis on one side or problems speaking, may be particularly severe. 

The warning signs of stroke are:

• Weakness - Sudden weakness, numbness or tingling in the face, arm or leg
• Trouble Speaking - Sudden temporary loss of speech or trouble understanding speech
• Vision Problems - Sudden loss of vision, particularly in one eye, or double vision
• Headache - Sudden severe and unusual headache
• Dizziness - Sudden loss of balance, especially with any of the above signs.

Anyone experiencing these symptoms should call 9-1-1 or their medical emergency number immediately.

Victims of an intracerebral hemorrhage may experience a change in their level of consciousness and a headache (usually described as “the worst I ever had”) may be accompanied by vomiting.  The only way to accurately distinguish the type of stroke that is occurring – and thus appropriate treatment – is immediate CT (commuted tomography ) scanning of the brain.  “All Canadians who present early with devastating stroke symptoms should be preferentially transported to hospitals with CT scan facilities,” says Demchuk.

To help improve the health outcomes after stroke, the Heart and Stroke Foundation of Canada and the Canadian Stroke Network are leading the development of a Canadian Stroke Strategy, with the goal that coordinated stroke care from prevention through treatment to rehabilitation be available in every province by 2010.

“It is more important than ever that people get to the hospital quickly and that timely access to acute stroke care is available across the country,” says Heart and Stroke Foundation spokesperson Dr. Daniel Selchen of Toronto. “In Ontario, for example, the development of integrated stroke care within the health care system doubled the proportion of ischemic stroke patients who received tPA.”

“This is an incredible time in stroke research and care,” says Sally Brown, CEO of the Heart and Stroke Foundation of Canada. “Twenty years ago, there were no treatments for either ischemic or hemorrhagic strokes. The clinical outlook was pretty grim.  Now new treatments are being developed and there is a better chance for survival and recovery for people who have a stroke.”