Clot busters limit stroke damage despite age; stroke severity

American Stroke Association Meeting Late-Breaking Science Report Abstract: LB 2 (Hall E)

February 12, 2014 Categories: Scientific Conferences & Meetings, Stroke News

Study Highlights:

  • Amidst lingering debate, a review by an international collaboration of stroke experts shows timely use of clot busters improves stroke outcomes despite patient age or stroke severity.
  • The clot-busting drug tPA can significantly reduce the risk of stroke effects for all subsets of patients if given within 4.5 hours of a stroke.
Embargoed until 11 a.m. PT/ 2 p.m. ET, Wednesday, Feb. 12, 2014
This release is featured in an embargoed media briefing at 9 a.m. PT Wednesday, Feb. 12

SAN DIEGO, Feb 12, 2014 – Regardless of a patient’s age, or severity of stroke, prompt treatment with a clot-busting drug limited stroke-related disability, according to late-breaking science presented at the American Stroke Association’s International Stroke Conference 2014.

The clot busting drug, tissue plasminogen activator or tPA is the only approved U.S. FDA treatment for acute stroke caused by a blood clot. However, there is still debate regarding the time window in which it should be given and its use in older patients or those with a minor or severe stroke.

An international collaboration of experts reviewed the records of 6,756 stroke patients participating in nine clinical trials. The experts reported that tPA worked better than placebo and decreased a patient’s odds of having long-term disability. Earlier treatment also improved outcomes. Among patients who received the clot buster:

  • Within three hours of stroke onset, 33 percent did not experience significant disability after stroke compared with 23 percent of those who did not receive tPA.
  • Between 3 and 4.5 hours of stroke, 35 percent did not experience significant disability after stroke compared with 30 percent of the placebo group.
  • After 4.5 hours from stroke onset, 33 percent of the tPA group had little disability compared with 31 percent of the placebo group.

“Our results may have implications for treatment guidelines on both sides of the Atlantic,” said Jonathan Emberson, Ph.D., study author and senior statistician from the University of Oxford in the United Kingdom. “In the United States, use of tPA is currently limited to treatment within three hours, while in some European countries use is limited to patients aged 80 or younger. The appropriateness of both of these restrictions may be revisited in light of our results.”

Prompt recognition of stroke symptoms and speedy treatment are the key to success.

“The problem causing the stroke is often a fresh blood clot, blocking the artery. tPA is a naturally occurring clot-dissolving drug, doing what nature designed it to do, said Kennedy Lees, M.D., joint study author and professor of Cerebrovascular Medicine at the University of Glasgow, United Kingdom. “If we give it early enough, while the clot is still fresh, it is extremely effective. The earlier the treatment is delivered, the bigger the expected benefits.”

Those who received tPA in a timely manner were significantly more likely to be free of stroke-related disability three to six months later based on the results of the modified Rankin scale

While the use of tPA was associated with a significant increase in the risk of potentially deadly bleeding in the brain in the initial phase of treatment, by three months after stroke, deaths in the tPA and placebo group were not significantly different.

Each year, about 795,000 Americans experience a new or recurrent stroke. tPA is approved to treat blood-clot related strokes in the United States within three hours of symptom onset. The American Heart Association recommends that tPA may be given up to 4.5 hours for some patients.

“tPA is under-used in older people, especially those aged over 80, so I am delighted these data support the use of tPA in this somewhat neglected patient group,” said Peter Sandercock, D.M., joint study author and professor of Neurology at the University of Edinburgh.

Based on these findings, the research team plans to investigate in greater details the effects of tPA, how it may further mitigate against stroke-related disability, and whether it would work in other types of patients.

Other co-authors are Patrick Lyden, M.D.; Lisa Blackwell, BSc; Gregory W. Albers, M.D.; Erich Bluhmki, Ph.D.; Thomas G. Brott, M.D.; Geoffrey Cohen, MSc; Stephen Davis, M.D.; Geoffrey Donnan, M.D.; James Grotta, M.D. George Howard, DrPH; Markku Kaste, M.D., Ph.D.; Masatoshi Koga, M.D., Ph.D.; Ruediger Von Kummer,  M.D.; Maarten Lansberg, M.D., Ph.D.; Richard Lindley, M.D.; Gordon Murray, Ph.D.; Jean Marc Olivot, M.D., Ph.D.; Mark Parsons, M.D., Ph.D.; Barbara Tilley, Ph.D.; Danilo Toni, M.D.; Kazunori Toyoda, M.D., Ph.D.; Nils Wahlgren, M.D., Ph.D.; Joanna Wardlaw M.D.; Gregory J. del Zoppo, M.D.; Colin Baigent, M.Sc.; and Werner Hacke, M.D., D.Sc.; for the Stroke Thrombolysis Trialists’ Collaboration. Author disclosures are on the abstract.

The U.K. Medical Research Council and British Heart Foundation funded the study.

Downloadable video/audio interviews, B-roll, animation and images related to this news release are on the right column of the release link http://newsroom.heart.org/news/clot-busters-limit-stroke-damage-despite-age;-stroke-severity?preview=b70685142715b2eb8fc6f106c4ddee41.

Video clips with researchers/authors of the studies will be added to the release links after embargo.

Follow news from ASA International Stroke Conference 2014 via Twitter: @HeartNews #ISC14

Statements and conclusions of study authors that are presented at American Stroke Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position.  The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

Note: Actual presentation is 11:23 a.m. PT, Tuesday, Feb. 12, 2014.

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