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EditorÃs Note: This is a revised news release. Changes are in bold.
EMBARGOED FOR RELEASE UNTIL 7:30 AM CST, WEDNESDAY, APRIL 29, 1998 Community Hospitals Successfully Treat Stroke with Thrombolytic Therapy
Use of the first treatment for acute stroke is effective in a community setting, according to a study released during the American Academy of NeurologyÃs 50th Anniversary Annual Meeting April 25-May 2 in Minneapolis, MN.
The ongoing study is following patients treated with the clot-busting drug tissue plasminogen activator (called tPA) since January 1996 at 31 hospitals in Minnesota.
When the National Institute of Neurological Disorders and Stroke (NINDS) reported its findings on the use of tPA for stroke, many questioned whether smaller community hospitals could manage the complex issues and potential hemorrhage risk. The NINDS study was performed by an NINDS-organized group that included academic and community hospitals, many with specialized stroke programs.
"This study looks at the results as use of tPA for stroke reaches the wider community," said neurologist Sandra K. Hanson, MD, of Park Nicollet Clinic in Minneapolis.
Of the 97 patients studied, 24 were treated at larger, academic hospitals and 73 were treated at community hospitals ñ 44 in the Twin Cities metropolitan area and 29 in smaller hospitals in Minnesota. The study will continue until about 300 patients have been followed, about the number who received tPA in the NINDS study. The NINDS study led to federal approval of the drug for use in stroke.
While the drug can improve recovery for stroke patients, use of the drug also increases the risk of hemorrhage, or bleeding, inside the brain that can be severe or fatal. Of the 97 patients, nine experienced significant hemorrhages that resulted in a change for the worse within 36 hours of treatment. Although that is a higher percentage than in the NINDS study, Hanson said the difference is not statistically significant.
"Obviously, we would like those numbers to be lower, but the number of patients in our cooperative is still small, so that percentage can change from week to week," Hanson said.
Also, in two of the hemorrhage cases there were significant deviations from the NINDS guidelines for treatment that probably put them at greater risk for hemorrhage, Hanson said.
"This just reinforces that itÃs absolutely imperative that we follow the protocol for this drug," Hanson said.
An unexpected finding in the study was that three of the patients with significant hemorrhages showed no or almost no signs of disability three months after the stroke.
"Everyone thinks of hemorrhage cases as cases that are always lost to severe disability or death, but thatÃs not true," Hanson said. "Some of these patients had fairly significant hemorrhages and still had good outcomes."
In the national study, patients who received tPA within three hours after the start of symptoms were 30 percent more likely to have little or no disability three months after a stroke than patients who received a placebo. The American Academy of Neurology and other organizations are working to raise awareness of the signs and symptoms of stroke and the need to treat stroke, or "brain attack," as a medical emergency.
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