Treating stroke: why some doctors are taking a second look at clot-busting drug

On average, someone in the United States has a stroke every 40 seconds.

So, what exactly is a stroke? It's a sudden interruption in the blood supply of the brain. Because stroke happens so quickly and requires immediate treatment, it's also called a brain attack.

About 87 percent of all strokes are ischemic, meaning they're caused by a blood clot in the brain. And for over 20 years, the gold standard to treat those types of strokes has been a drug called TPA.

But now, some doctors are questioning whether TPA is the best bet for patients.

When it comes to a stroke, time is critical. TPA, the only clot-busting drug approved to help lessen the damage, has to be given within three hours.

But research shows not everyone who arrives to the hospital on time receives TPA. In fact, up to 30 percent of stroke patients who are good candidates for the drug don't get it. The reason? Some doctors are skeptical, saying some studies are flawed and that the drug poses a risk of bleeding.

Dr. George J. Shaw is a critical care specialist at the University of Cincinnati College of Medicine.

"Even if it's given properly, about 6 percent of people will have bleeding in the brain just from the TPA. I've seen that a couple of times. It's never good. It's always bad," he said.

Still, the American Heart Association and the American Stroke Association strongly endorse the use of TPA in appropriate patients, calling it the "gold standard."

The landmark research that first brought attention to TPA happened more than 20 years ago. And since then, other studies have shown its benefits in reducing disability after stroke.

"About one-third of folks, if you look at them six months after their stroke and if they've gotten it, tend to do better neurologically than those who haven't gotten TPA," Shaw said.

While TPA might be the only treatment for stroke, experts said it's not one without risk.

There are also results from studies that are shedding new light on how the brain responds after stroke, and how long doctors have to effectively treat a patient.

"The big news is that we were all wrong in how we were thinking about how strokes evolve," said Gregory W. Albers, professor of neurology at Stanford University Medical Center.

While TPA continues to be the accepted treatment for ischemic strokes, some are now calling for more research to prove that the benefits outweigh the risks.
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