In mild strokes, ultra-early treatment may eliminate risk of disability


In the case of mild or moderate strokes, getting treatment ultra-fast (within 90 minutes of experiencing symptoms) greatly reduces the risk of suffering disability, according to a new study reported in the American Heart Association’s journal, Stroke.

According to guidelines, clot-busting drugs may be given to treat stroke up to 4.5 hours after the onset of symptoms.

The study found that survivors with mild to moderate strokes who were given alteplase in the first 90 minutes of the recommended time window had little or no disability three months later compared to those who were treated between 90 and 270 minutes.


“Ultra-early treatment increases the likelihood of excellent outcome in patients with moderately severe symptoms, and in secondary analysis also in those with mild symptoms,” said Daniel Strbian, Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. “All measures must be taken to reduce onset-to-treatment time as much as possible.”

The study included more than 6,800 stroke patients at 10 stroke centres in Europe over 14 years. They were treated intravenously with alteplase, a clot-busting drug that is given intravenously. Patients were separated into three groups based on stroke severity—minor, mild/moderate, or moderate/severe. Those with mild to moderate stroke seemed to benefit most from the ultra-early care. Early treatment also helped those with minor strokes, but the likelihood of disability is already very low in these patients.

“In the whole cohort, shorter onset-to-treatment time as a continuous variable was significantly associated with excellent outcome (p<0.001). Every fifth patient had onset-to-treatment time≤90 minutes, and these patients had lower frequency of intracranial haemorrhage. After adjusting for age, sex, admission glucose level, and year of treatment, onset-to-treatment time≤90 minutes was associated with excellent outcome in patients with National Institutes of Health Stroke Scale 7 to 12 (odds ratio, 1.37; 95% confidence interval, 1.11–1.70; p=0.004), but not in patients with baseline National Institutes of Health Stroke Scale>12 (odds ratio, 1.00; 95% confidence interval, 0.76–1.32; p=0.99) and baseline National Institutes of Health Stroke Scale 0 to 6 (odds ratio, 1.04; 95% confidence interval, 0.78–1.39; p=0.80). In the latter, however, an independent association (odds ratio, 1.51; 95% confidence interval, 1.14–2.01; P<0.01) was found when considering modified Rankin scale 0 as outcome (to overcome the possible ceiling effect from spontaneous better prognosis of patients with mild symptoms). Ultra-early treatment was not associated with mortality,” Daniel Strbian, Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland and colleagues wrote.


“We need more research to offer something more for people with severe strokes,” Strbian said.