A research study reported in Neurology Today suggests that giving recombinant tissue plasminogen activator (rtPA) to eligible patients with mild strokes could prevent 2,000 cases of disability annually and save $200 million in health care costs annually.
This study provides new information about the use of rtPA in mild stroke patients and is significant because one in three patients who suffer a mild stroke experiences some disability three months later. Dr. Pooja Khatri anaylzed records from 437 patients with mild stroke —all admitted within the 4.5 hours of stroke onset recommended window for treatment with rtPA. Of the total, 251 were considered to have mild strokes, with a score of 5 or less on the 42-point National Institutes of Health Stroke Scale (NIHSS). Only four (1.0 percent) were given rtPA. However, 150 (62 percent) of the remaining patients would have been candidates for the drug if the mildness of their stroke was disregarded as a reason to deny them tPA treatment. Extrapolating these population–representative figures to the entire nation, 43,180 people with mild strokes would be eligible for tPA each year.
rtPA – the only FDA-approved medication to reduce permanent disability from ischemic stroke – breaks up clots, allowing blood flow to be restored to the brain, and reduces or eliminates disability in at least 30 percent of patients who receive it. rtPA isn’t without risks, chiefly brain bleeding. But studies suggest people with mild stroke are less likely to have a hemorrhage than those with the more severe strokes in which it is routinely used.
Stroke, or brain attack – already the third leading cause of death in the US behind heart disease and cancer – is projected to grow as the epidemic of obesity grows because about 80 % are Ischemic and related to fatty plaque in blood vessels breaking loose to form blood clots that block the flow of blood to the brain. About 20 % of strokes are classified as hemorrhagic and result from a broken blood vessel in the brain itself. Younger people have proportionately more hemorrhagic strokes due to less arterial plaque.
CDC reports hospitalizations for people aged 5 to 45 with ischemic stroke rose sharply between 1994 and 2007. About one quarter of all strokes occur in younger people, including children. Strokes – even mild ones – can lead to temporary or permanent disabilities and can cause serious disabilities ranging from speech, cognitive and emotional difficulties, to pain and paralysis. Having had any stroke increases your risk for a second, often fatal stroke.
The American Heart Association reports about 17 percent of the 795,000 strokes that happen annually in the U.S. are fatal. The biggest risk factors for stroke are the same as for a heart attack — smoking, heart disease, diabetes, high blood pressure, irregular heartbeat, and high cholesterol. AHA suggests that steps be taken to reduce stroke risk, especially for those under 45: Eat a healthy diet; Maintain a healthy weight; Be physically active; Don’t smoke; Limit alcohol use; Prevent or treat high cholesterol; Prevent or treat high blood pressure; Prevent or treat diabetes; Talk with your doctor about the best ways to lower your risk for stroke.
Know the closest hospital that treats stroke with rtPA and be able to identify stroke onset symptoms in yourself or another person quickly. Signs of stroke occurring (usually painless) include: Sudden numbness or weakness of the face, arm, or leg; Sudden confusion or trouble speaking or understanding others; Sudden trouble seeing in one or both eyes; Sudden dizziness, trouble walking, or loss of balance or coordination; Sudden severe headache with no known cause.
Take immediate action if you experience stroke-like symptoms that are different from migraines you’ve had before, and if unsure, call 911 immediately.
