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The Necessity of Early Care for Stroke Victims

Posted on Aug 28, 2013 by Ailee Slater ()  | Tags: clotbusters, clotbusting drugs, early stroke treatment, rapid treatment centers for stroke victims, stroke, thrombolysis

Doctors and nurses have always known the importance of treating a stroke as soon as possible, but a new study from the medical journal, Stroke, has shown just how important it is to diagnose and offer care to stroke victims as soon as possible. 

Published in August 2013, the study demonstrated that in order to greatly minimize the brain damage of a stroke, victims should be given an anti-clotting drug within 90 minutes of when the stroke occurs. Commonly known as clotbusters, these drugs fight blood clots to return blood flow to the brain - a treatment of extraordinary importance because during a stroke, the patient's brain isn't receiving blood. If such a disturbance lasts for any longer than a short period of time, brain cells will expire and the patient will risk brain damage which may result in future medical problems: linguistic impairment, difficulty performing simple physical tasks, and similar issues requiring physical and speech therapy.

Researchers in the Stroke study observed patients in 10 stroke centers across Europe, trying to discover if patients given early thrombolysis (the term for breaking down blood clots with the use of pharmacological treatment) fared significantly better than patients who were not given clotbusters until an hour or two later. In the United States, clotbusters are only approved for use by the Food and Drug Administration when given to a patient within three hours of the stroke; waiting any longer would, according to the Administration, severely limit the helpfulness of such drugs. Generally, clotbusters are recommended for use within four to five hours of the initial stroke, always with the caveat that the sooner a drug is given, the better.

Despite these norms, however, the Stroke study did indeed find significant health benefits to patients who received thrombolysis within the first 90 minutes of having a stroke. Researchers noted that patients given a clotbusting drug very early into the stroke showed much stronger recovery and far less brain damage than patients not given a clotbuster until an hour or two later. Patients receiving thrombolysis within that first 90 minutes also showed a greatly lessened risk of developing a long-term disability as a result of the stroke.

Unfortunately, the results of this study shine little light on how to overcome the issues that currently prevent stroke victims from receiving clotbusters as early as possible. To begin, doctors cannot give a patient a clotbusting drug until they have assessed the patient to learn what type of stroke she is experiencing. If the patient is undergoing a normal stroke, in which a blood clot is blocking blood flow to the brain, a clotbuster can do a great deal of good. However, if the patient is suffering from a less-common hemorrhagic stroke - in which a blood vessel has burst in the brain - a clotbusting drug could damage the brain further and easily lead to fatal bleeding.

Even if a patient is suffering from a normal rather than a hemorrhagic stroke, a doctor will normally want to do a brain scan and review the patient's medical history before prescribing a clotbusting drug. This sort of analysis can take time, which is why some stroke advocates have called for more hospitals to create rapid treatment centers for stroke victims. At a rapid treatment center, doctors would be equipped to diagnose and treat patients much faster than they would be treated at the ER. Because time is very much of the essence to a stroke victim, as shown in the Stroke study, a rapid treatment center could mean big benefits for stroke patients - and good results both medical and financial for hospitals that choose to build such centers.

Along with better treatment options, stroke victims also need quick diagnoses in order to ensure quick thrombolytic care. The new Stroke study is a good reminder to the public that when it comes to a stroke, time if of the essence, and it is therefore important to call an emergency number immediately upon recognizing the signs of stroke in oneself or another person. Some symptoms of a stroke include a slack jaw, difficulty moving an arm, or slurred speech. Other, less common signs of stroke are issues with clarity of vision and the unexplained occurrence of poor coordination.

The Stroke study did find that the positive effects of early treatment were not as significant for patients who has experienced a severe stroke; possibly because the sizes of those blood clots may have been too large to be affected by clotbusting drugs. For patients experiencing mild to moderate strokes, however, this recent research definitely implies that improving emergency care to give stroke victims rapid treatment is essential to minimizing long-term risks, and to giving those patients the greatest chance of recovery. Better training for ER doctors, development of rapid treatment centers and more public information campaigns may all be part of the process of reducing the risks of stroke by making speed a priority in every stroke victim's initial care.

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